Adoption Form Pet Adoption Application Step 1 of 6 16% Pet Name* Name* First Last Phone*Employer* Occupation* Drivers License Number* Email* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How long have your lived at your current address?* Years / MonthsDo you rent or own? Rent Own Landlord's Name First Last Landlord's PhoneLandlord's Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do you have a fenced yard? Yes No Fence Height (feet) Fence Type Chain link, Wood, PicketAre you prepared to walk your dog multiple times daily, in spite of weather conditions? Yes No Why do you want to adopt an animal? Has your entire family discussed adopting a pet? Yes No Do you have children under 18 years of age? Yes No ChildrenNameAge How will you handle unwanted behaviors? How much time will you allow your new pet to adjust to your home? Who will be responsible for taking care of the dog / cat? How many hours per day will the dog / cat be alone? Where will the dog / cat stay when no one is at home? Where will the dog / cat stay when you are home? How often will you exercise your pet? Who will care for your pet when you are out of town (vacation, work, etc.)? Under what condition(s) would you have to give up your dog / cat? Have you ever given an animal away or relinquished it to a shelter? No Yes Why?* Do you have pets in your home now? Yes No Current PetsName of PetBreedAge Are all your current pets Licensed? Yes No Are all your pets spayed or neutered? Yes No Are all your current pets up-to-date on vaccinations? Yes No Do your current pets have heartworm and flea/tick prevention? Yes No Are you aware of costs and responsibility for health care, food, and heartworm/flea prevention? (total cost can be $50 a month or more) Pets you have had in the last 5 years (if not listed above)Past PetsName of PetBreedReason no long with you Name of Current Veterinarian's Practice Current Vet's Name First Last Vet's PhoneVet's Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Agreements for Adoption I am prepared to make a 10 to 20 year commitment to my cat / dog. I keep my dog on a regular routine of heart worm preventative. I will provide flea/tick control as needed. I will work with my vet and agree on a regular schedule for wellness visits, inoculations, and any other tests we agree are necessary for the health and well-being of my dog / cat. I will not chain or tie-up my dog / cat and leave it outside alone. My dog / cat will be and indoor dog / cat and an important members of my family. If, for any reason, I am unable or unwilling to keep this dog / cat, I agree to return him / her to the Original Pet Owner. I will not give this dog / cat away, take it to a shelter, place him / her with another person or family. I am financially able to provide routine and emergency care for this dog / cat for his / her lifetime. This includes but is not limited to food, boarding (if necessary), regular vet care, heart worm preventative and flea and tick preventative. Do you agree with the terms above?* YES By checking this box, you are acknowledging your agreement with the statements above.NameThis field is for validation purposes and should be left unchanged.