Adoption Questionnaire

Name of Pet you are interested in*

Date of Application*

Name*

Address*

City*

State*

Zip*

Phone*

Alternate Phone

Email*

Is this pet for you, your family or a gift for someone else?* —Please choose an option—For MeFor FamilyA Gift

What are the ages of children under 18 who live with you?*

What are the ages of children who often visit you?*

Why do you want to adopt this pet?*

How many dogs do you have?* —Please choose an option—0123456

How many cats do you have?* —Please choose an option—0123456

Breed, age, sex*

Are all pets Spayed/Neutered?* YesNo

Are all pets Vaccinated?* YesNo

Is your dog on heartworm preventative?* YesNo

If not on heartworm preventative, why?

Have you had pets other than those listed above in the past 5 years?* —Please choose an option—DogCatThis is my first pet

What happened to them?

Do you own or rent?* —Please choose an option—OwnRentLive with parents

Do you live in* —Please choose an option—HouseApartment/Mobile Home

If you rent, do you have approval from your landlord to have a pet?
YesNo

If interested in adopting a dog, will this dog be allowed in the house?
YesNo

Do you have a fenced yard?* YesNo

What type of fence and how high?

If you do not have a fence, how will you provide exercise and bathroom time for your dog?

If interested in adopting a cat, do you plan to declaw this cat?
YesNo

If Yes, why?

Name of Veterinarian and Clinic*

Veterinarian's Phone Number*

*Required Information

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