Name of pet you are applying for
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Your Full Name
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First Name
Last Name
Date of Birth
MM
DD
YYYY
Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Home Phone
(###)
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Cell Phone
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(###)
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Email
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Employer
Employer Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Employer Phone Number
*
(###)
###
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Your Position
Are you familiar with the breed of the pet you have selected
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Yes
No
Please list household members. (name, age, relationship to you)
Who will be the primary owner/caretaker of the pet you are applying for
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Please describe your household activity level
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Quiet
Moderate
Active
Very Active
Type of home
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Single Family Home
Townhouse
Apartment
Mobile Home
Other
If you chose other, please explain
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Do you rent or own your home?
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Own
Rent
Do you have a fenced yard?
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Yes
No
Please list all current pets along with other pets you have owned in the past 5 years. Include name, type of pet, breed, gender, spayed/neutered, years owned, indoor or outdoor pet.
*
If no current pets please write "N/A"
Are any of your cats declawed?
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Will the pet have access to a fenced in yard?
Are you a first time pet owner?
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Yes
No
Is this your first time adopting from an animal rescue?
Yes
No
Are you ready to be responsible for the pet for its entire life?
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Are you financially able to care for the pet. This includes food, bedding, toys, yearly exams, vaccinations, flea/tick prevention and possible medical emergencies?
How will you introduce your new pet to your current pets?
How many hours in the day will your pet be home alone?
Where will your pet be kept when you are home? (free to roam in my home, first floor only, second floor only, yard, basement, etc.)
Where in the home will your pet be while you are at work? ( in a cage/kennel, free to roam around, in a separate room, etc.)
How much time will you have for your new pet?
How do you plan to exercise your dog ? If so, how often?
If not applying for a dog please write "N/A"
Where will your pet stay when you are away from home or on vacation?
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Where will your pet sleep? ( on my bed, next to my bed, in his/her own bed, in cage, outside, etc)
If a behavioral problem arises, what steps will you take to resolve it?
Have you ever taken one of your pets to a shelter or given an animal away? Please explain circumstances.
We understand unexpected things happen in life. What will you do with your pet if you are presented with any of the following situations:
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1. If your landlord does not allow your pet in the home anymore?
2. If you have a new baby?
3. If you or anyone at home becomes allergic to the pet?
4. If you are no longer able to care for your pet due to time/finances?
It will take time for your new pet to adjust to your home. How will you try to make the transition easier for you and your pet?
Changing a pet's environment may cause your pet to have accidents at home. How will you handle housebreaking issues if the problem arises within the first few days of your pet being home?
If your pet became seriously ill or injured, what steps will you take to provide veterinary care?
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If in case things do not workout with your new pet, and you feel you are no longer able to care for him/her, please let us know immediately and we will help rehome your pet. Is this something that you are able to do if needed?
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Reference one
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First Name
Last Name
Phone Number
*
(###)
###
####
Email
*
Relationship to you
*
Reference Two
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First Name
Last Name
Phone Number
*
(###)
###
####
Email
*
Relationship to you
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Veterinary Office name/ Vet's Name
Office Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Office Phone Number
(###)
###
####
If you use more than one vet, please provide the secondary vet's contact details.
If you have any additional comments, please provide them below
I have read and agree to these terms and conditions
*
Yes
No
Electronic Signature
*
Today's Date
*
MM
DD
YYYY
How did you hear about our organization?