Name of Pet you are interested in*
Date of Application*
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?
If interested in adopting a dog, will this dog be allowed in the house?
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?
If Yes, why?
Name of Veterinarian and Clinic*
Veterinarian's Phone Number*