Name:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
  
E-mail Address:
Name of pet you are
interested in adopting:
Is this your first experience
with this type of pet:
List the pets you currently
have in your household:
Pet #1

Name: Age:

Type: Spay/Neuter:
Kept:
Pet #2

Name: Age:

Type: Spay/Neuter:
Kept:
Pet #3

Name: Age:

Type: Spay/Neuter:
Kept:
List pets owned in the last
five years (other than those
listed above):
Pet #1
Type: Spay/Neuter:
Where was the pet kept:
Where is the pet now?
Pet #2
Type: Spay/Neuter:
Where was the pet kept:
Where is the pet now?
Pet #3
Type: Spay/Neuter:
Where was the pet kept:
Where is the pet now?
Who is your veterinarian:
Vet's Phone Number:
Your current residence is:





Do you own or rent:

If you rent, does your
lease allow pets:
If you rent, what is the
landlord's name:
Landlord's phone number:
  
Do all the adults in your
household know that you
plan to adopt?
If there are children in your
home, what are their ages:
Where will this pet be kept
during the day?
During the night?
How many hours a day
will it spend alone?
Where will the pet be kept
when it is alone?
Do you plan on spaying or
neutering your pet?
How did you hear about
our adoption service?
Do you want the dog for a:






Do you have a fenced yard?
If yes, what kind
and how high?
Do you realize you will
probably have to
house-train your puppy
or dog?
Would you like information
on how to house-train
your puppy or dog?
Are you familiar with the
leash and licensing laws in
your community?
Are you familiar with
heartworm disease?
How will you keep your dog
confined to your property?