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Pet Adoption Application
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Animal Name
*
Gender
*
Male
Female
Breed
*
Applicant Information:
Name
*
First
Last
Cell #
*
Address
*
Address Line 1
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Number of adults in household/Ages
Number of children in household/Ages
Type of Residence
Condo
House
Apartment
Townhouse
If you are in a condo or apartment, what floor are you on?
If You Rent
Landlord Name
First
Last
Phone
Homeowner’s Association?
*
Yes
No
Any Pet Restrictions?
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Size
Weight
# of Pets
Breed Restrictions?
Do you have a pool?
Yes
No
Yes and it's enclosed
Yes, but it's not enclosed
Do you have a fenced yard?
Yes
No
If yes, what is the height of your fence?
What is your fence made of (wood, metal, chain link, etc.)?
Employment Information:
Work from home?
Yes
No
Employer
Work Phone
Working Hours
Attend School?
Yes
No
Yes and someone is home during the day
Yes, but no one is home during the day
How many hours per day will your pet be without human companionship?
Pet Information:
Do you have current pets?
Yes
No
If Yes, please fill out below. If No, have you had pets in the past?
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Name (Pet 1)
Current Location?
Breed
Gender
Male
Female
Age
Reproductive Status
Neutered
Spayed
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Name (Pet 2)
Current Location?
Breed
Gender
Male
Female
Age
Reproductive Status
Neutered
Spayed
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Name (Pet 3)
Current Location?
Breed
Gender
Male
Female
Age
Reproductive Status
Neutered
Spayed
Veterinarian Information:
Veterinarian’s Name
First
Last
Veterinarian’s Phone
Address
Address Line 1
Address Line 2
City
--- Select state ---
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Are your current pets up‐to‐date?
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Vaccines?
Yes
No
HW prevention?
Yes
No
Flea Prevention?
Yes
No
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Have you ever given an animal away or relinquished an animal to a shelter?
Yes
No
Where will your dog be housed during the day?
Crated
Inside loose
Other
If yes, what were the circumstances?
Where will your dog be kept when unsupervised or when left alone?
Crated
Inside loose
Other
Where will your dog sleep?
Crated
Inside loose/bed
Other
Who in the household will be the dog’s primary care giver?
In case of emergency, who will care for your dog?
How many times per day do you plan to take your dog outside?
Email
*
Submit