Dog/Cat’s Name/ID Date (example: mm/dd/yyyy) Name Address City State Zip Email Primary Phone Secondary Phone Date of Birth (example: mm/dd/yyyy) Driver's License # Place of Employment Work Phone Your Location Details Do You: Rent Own Live with Parents Do you live in: House Condo Apartment Mobile Home If you rent, what is your pet deposit and weight limit? Landlord's Name Landlord's Phone List all persons living in your household. Name Age Name Age Name Age Name Age Name Age List 3 references names and phone numbers Name Phone Name Phone Name Phone Provide pet related details Have you ever adopted from us before? Yes No If yes, do you still have the pet? Yes No Will this be a pet be an inside or outside pet? Do you have a fenced yard? Yes No If yes, what kind and how tall? Where will this pet be kept during the day? How long will this pet be left alone during day? Age preferred? Oldest you would consider adopting? Sex of dog/cat you prefer? Male Female Dog/Cat you are interested in? What are your particular preferences for a dog/cat, such as: “doesn't get on furniture”, “must like cats”, “must like dogs”, “good with children”, etc.? What will you do if your dog/cat is destructive while alone? List unacceptable behavior issues How will you discipline your new dog/cat? Would you attend obedience class with your new dog? Yes No What would justify getting rid of a pet? List all of the pets currently in your household and the ones you have had in the last 5 years Name Breed Spayed/Neutered Age What happened? Name Breed Spayed/Neutered Age What happened? Name Breed Spayed/Neutered Age What happened? Name Breed Spayed/Neutered Age What happened? Veterinary Clinic Name Phone Submit Application Adopt Foster Donate Volunteer Follow
