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Adoption Form

Today's Date
Month
Day
Year
Date of Birth
Month
Day
Year
Multi-line address
Do you Own or Rent?
Own
Rent
Do you live in a. . . .
House
Apartment
Condo
Mobile Home
Duplex
Townhouse
If you lease, does your lease allow pets?
Yes
No
N/A
Is there a pet deposit?
Yes
No
N/A
Do you have a roommate?
Yes
No
Do all members of the household know you are planning to adopt a pet?
Yes
No
Are you 18 years of age or older?
Yes
No
Are you or your spouse currently employed or retired?
Working
Retired
Reason for adopting this Pet?
Child's Pet
Family Pet
Companion
Watch Dog
Guard Dog for Business
Breeding
Hunting Dog
Other
Are you interested in adopting for. . .
Yourself
Family
Someone Else
Will an adult be home during the day?
Yes
No
Part of the day
If adopting a dog or puppy, what procedures will you use for housebreaking?
Crate Training
Newspaper
Rubbing Nose
Swatting with Newspaper
Outside Only
Other
If adopting a dog or puppy, how will you handle scratching or destructive behavior?
Loud No
No Can
Water Gun
Swatting with Newspaper
Outside Only
Other
If adopting a dog or puppy, what plans do you have for basic obedience training?
Videos
Classes
Books
In home lessons
None
Other
Do you presently have pet insurance?
Yes
No
Are your pets micro chipped?
Yes
No
Have you ever turned in an animal to an animal shelter?
Yes
No
Do you have a fenced in yard?
Yes
No
For which of the following reasons would you give up your pet?
If you currently own a dog, is it on heartworm preventative?
Yes
No
May we contact your Veterinarian?
Yes
No
Would you object to an authorized representative inspecting the animal and premises where the animal is being kept?
Yes
No
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APPLICANT SIGN HERE

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GUARDIAN SIGN HERE

Date Application completed
Month
Day
Year

Verification

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