Applicant Information |
Name: Date: |
E-mail address: |
Home Phone: | Work Phone: | Alt. Phone: |
Current Address: Length at address: |
City: | State: | ZIP: |
Drivers License #: | Drivers License State: |
Employer: | Employer’s Phone: |
Own Rent Live with parents (please circle one) | House Apartment Townhouse Duplex Condo Mobile Home Other: ______________________________ |
Landlord’s name: | Landlord’s phone number: |
Are you a student? Yes ___ No___ High School College Undergrad Graduate |
Personal Information & References |
Spouse’s Name: |
Spouse’s Employer: | Employer phone: |
List names and ages of members of household: |
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List names & phone # for 2 Character References |
1. |
2. |
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Pet Information |
List all of your current pets: |
Dog | Cat | Other | Lives In or Out | Spayed/Neutered | Name | Breed | Age |
| | | In___ Out___ | Yes___ No___ | | | |
| | | In___ Out___ | Yes___ No___ | | | |
| | | In___ Out___ | Yes___ No___ | | | |
| | | In___ Out___ | Yes___ No___ | | | |
If your pets are not spayed/neutered please explain: |
List all of your previous pets: |
Dog | Cat | Other | Lived In or Out | Spayed/Neutered | Name | Breed | What happened to the pet? How long ago? |
| | | In___ Out___ | Yes___ No___ | | | |
| | | In___ Out___ | Yes___ No___ | | | |
| | | In___ Out___ | Yes___ No___ | | | |
Name of Veterinarian or Clinic: | Phone # of Vet/Clinic |
Adoption Information |
Why do you wish to adopt this animal? Gift Companion Hunting Guard/Security Mouser Breeding (please circle one or more) Other: ____________________________ |
Where do you plan to keep this animal? Inside Home Outside Home Backyard Outside Pen Garage (please circle one or more) Chained/Tied Basement Crate Other:______________________ |
Do you have a fenced yard? Yes___ No___ | Dimensions: | Do you have a dog house? Yes___ No___ |
Type of Fence: Chain Link Wood Electric Invisible Welded Wire Picket Other_________________ |
How many hours a day will this animal be left alone? | Where will it be kept when left alone? |
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Will you agree to spay/neuter this animal? Yes___ No___ | Have you dealt with us before? Yes___ No___ If so, how and when? |
How do you feel about Crating a dog? |
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Would you allow a Shelter Representative to visit your home? |
If adopting a puppy or kitten under 6 months of age do you agree to have the animal spayed or neutered? |
What kind of Research have you done on the particular Breed or type of animal you are planning to adopt? |
Are you aware that pets require routine Veterinary Care? |
How much do you anticipate monthly expenses including food, heartworm prevention and flea & tick prevention for a pet to be $ | |
