DATE: NAME ADDRESS CITY, ZIP PHONE (S) APPLICANT’S DATE OF BIRTH ANIMAL SELECTED: TYPE: CAT DOG NAME OF PET INTERESTED IN ADOPTING: Do you live in a HOUSE CONDO APARTMENT MOBILE HOME Do you OWN RENT LANDLORD NAME PHONE Do you plan to move or go on vacation soon? YES NO Do you live with: PARENTS SPOUSE CHILDREN ROOMMATE ALONE What are the ages of any children in your household: Who is your veterinarian? LOCATION,PHONE LIST ALL PETS YOU HAVE HAD IN THE LAST 5 YEARS. INCLUDE CURRENT PETS AND THOSE YOU NO LONGER OWN: BREED AGE SEX SPAY/NEUT? OWNED HOW LONG ? WHAT HAPPENED TO IT? COMPLETE THIS SECTION FOR PUPPY/DOG ADOPTION: Reason for wanting dog: WATCHDOG COMPANION BREEDING GIFT HOUSE PET FOR KIDS PROTECTION HUNTING OTHER As a puppy, where will this pet be kept during the day? Where will this pet be kept at night? As an adult, where will this pet be kept during the day? Where will this pet be kept at night? Puppy/Dog Adoption Continued: How do you plan to confine this pet to your property? Do you have a fenced yard? YES NO FULLY FENCED PARTIALLY FENCED Approximately how many hours will this dog be alone during the day? Who will have primary care of this dog? In what activities do you plan to include your dog? How would you housebreak this dog? What are your plans for training this dog? COMPLETE THIS SECTION FOR KITTEN/CAT ADOPTION: Reason for wanting cat: HOUSEPET MOUSER BREEDING GIFT COMPANION FOR CHILDREN BARN CAT OTHER Where will the cat live? INDOOR ONLY OUTDOOR ONLY INDOOR/OUTDOOR How much time each day will the cat be INDOORS?OUTDOORS? How long after adoption would you start allowing your cat/kitten outdoors? Where will this cat sleep? Where will the cat spend the night? Who will have primary care of this cat? What do you plan to feed your cat? What would you do if your new cat is not using the litter pan? Do any members of your household have known allergies to cats? Many factors go into determining which applicant will be matched with a particular animal. If you are not chosen for this pet, it does not mean that you are not considered a good pet owner or that your home is not acceptable. Our goal is to place this animal in the home that will best suit its needs. I have completed this application truthfully and I understand the application process. SIGNATURE (can type name) Please save application and email the completed saved application to us.