Name
*
First Name
Last Name
Email
*
I am looking for a:
*
dog
puppy
cat
kitten
If are interested in a specific pet, how did you learn of it?
website
petfinder
facebook
mobile adoption
other
Breeds you are interested in
Approximate Age Preference
Color Preference?
Please answer the following questions about your living enviornment as honestly as possible. This will enhance our chances of successfully matching you with an appropriate pet, and will reduce the possibility of you later having to return the animal due to incompatibility problems
*
Number of Adults (including yourself) over 21 residing in the household, and their ages.
Do you prefer a male or female pet?
*
male
femail
Either
Do you require that your pet be house-trained?
*
yes
no - I am willing to train my pet to be house trained
Doesn't matter
Do you want your pet to be crate trained?
yes
no - I am willing to crate train my pet if needed
doesn't matter
If you are interested in a cat, must it already be litter trained?
yes
no - I am willing to litter train my cat
If looking for a dog, what type do you prefer?
companion
hunter
guard
couch potato
if dog or puppy, maximum size when fully grown
small
medium
large
very large
Number of adults (including yourself) over 21 residing in the household and their ages.
*
Number of children under age 21 residing in the household and their ages
Is anyone in the household allergic to dogs or cats?
*
yes
no
If yes, who?
Is anyone in the household physically challenged?
yes
no
How long have you lived at your current address
*
If yes, please explain:
Do you live in a
house
apartment
condo
duplex
mobile home
townhouse
Do you
*
own
rent
lease
If less than 1 year please list previous address
If you rent your home, list any pet restrictions (breed, weight, etc.)
If you rent or lease your home, please provide your landlord name, address and phone number below. If renting or leasing, we will contact your landlord to verify that having pets in your home is acceptable.
Are you employed?
*
yes
no
If yes, name of employer
If employed, please list the name of your Supervisor and their work phone number
Do you have a Veterinarian?
*
yes
no
Veterinarian name:
Veterinarian address
Veterinarian phone number
(###)
###
####
Name on account at Veterinarian
In the spaces below, please list all pets that currently live at your address. Be sure to list all information for each pet: Name/ dog or cat/ age/ male or female/ spayed or neutered/ current on vaccinations/ how long owned
Additional pets in household
Do your dogs/cats get along with other dogs/cats
yes
no
unknown
Are any of your dogs food aggressive?
yes
no
unknown
Do you have a completely and securely fenced yard?
yes
no
Radio
Option 1
Option 2
Type and height of fence
If no fenced yard, how will you control your dog when outside?
On an average day, how many hours will the pet be alone?
Where will the pet be kept when someone is home?
Where will the pet be kept when no one is home?
Where will the pet sleep at night?
Prior Experience with pets: have you had a dog or cat previously
yes
no
If yes, tell us what happened to it/them? (you still have them, they passed away etc.)
How would you describe your level of experience with dogs/cats (check all that apply)
Never had a
dog
cat
Had a childhood pet
dog
cat
Had one or more as an adult
dog
cat
Have experience working with behavioral problems with a trainer
dog
cat
If interested in a dog, do you have experience with x-large or bully breeds?
yes
no
If you have ever been investigated by Animal Control or had a pet impounded, if yes please explain.
Have you ever had an application to adopt a cat or dog denied?
yes
no
If yes, when (date) and by which agency?
Reason for denial
Please tell us anything else about yourself that might help us match you with the right animal
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Drivers License State and Number
*
Text
Date
MM
DD
YYYY
cell or work phone
*
(###)
###
####
If you are interested in a specific pet what is its' shelter name?