Today's Date Interested In * Please Fill in Name of Animal Name * Birthdate * Do you have a spouse or significant other living with you?YesNo Spouse/Partner Spouse/Partner Birthdate Address * Please do not use special characters when entering phone. Enter only numbers. Example: 4105551212. Thank you Phone * Please do not use special characters. Only numbers Ex. 4105551212 Email * Have you EVER been charged with animal cruelty or animal neglect? YesNo Please explain any charges In the past 10 years, have you had any pets that were lost, stolen or given awayYesNo Please Explain if Lost, Stolen or Given Away Under what circumstances would you surrender (give up) a pet, explain in detail: (Examples: new baby, divorce, marriage, new pet, illness, moving, etc) If you are adopting a cat, do you plan on declawing the cat? YesNo Do you have children or anyone else residing in your home?YesNo Names and Ages of Residents Have your children lived with pets in the past?YesNo How will you teach your children the correct way to interact and respect your pets? Do all members in your household agree upon this adoption?YesNo Is anyone in your home allergic to animals of any species? YesNo Do you have any pets currently residing in your home? * YesNo List each animals name, breed, sex and age below: Are your current pets up to date on vaccines? YesNo If not, which ones, and explain why not: Are your current pets spayed and/or neutered? YesNo If not, which ones are not spayed/neutered, explain why Are your current pets on Heartworm Prevention?YesNo Please list your current Veterinarian’s name and contact information: Do you agree that whichever pet you adopt will be kept as indoor family pet?YesNo Do you agree to feed each pet daily with fresh water and healthy food?YesNo Do you own or rent? * OwnRent Please list your landlord or property owner's name & contact information below: Do you have any breed or weight restrictions with your landlord, property owner, homeowners insurance or HOA? * YesNo Do you have a yard? * YesNo What do you plan to do for bathroom breaks and exercise needs? If so, is your yard securely fenced in? YesNo If so, please describe fence type and height (i.e. chain link, wood, split rail) What is the maximum number of hours this pet will be left alone during the day? Are you employed?YesNoRetired Employer Name and Address: How long have you worked there? Do you understand that it takes time for an animal to adjust to its new surroundings and behavioral issues may occur? * YesNo What behaviors do you consider unacceptable behavior in a pet and how will you work on these issues? * Are you willing to allow a 60-90 day adjustment period for your new pet to adapt to your home, your family, your routine and any other pets? * YesNo Many prospective adopters are surprised at the cost of food and medical expenses that are necessary to keep an animal in good health. During the first year you should expect to spend $300 - $500 for routine healthcare. Are you willing to make this financial commitment? * YesNo Do you agree to provide for this animal for the entirety of his/her life? * YesNo Please list 2 personal references (no relatives) who you have known for at least 5 years (include phone number and email address). *** Please be aware...Incomplete or empty reference fields will cause your application to be returned or denied.*** Reference 1 * Reference 2 * Prev Next Submit Categories: