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    • Spay Neuter Assistance Program
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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?*

    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?*

    How many cats do you have?*

    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?*

    What happened to them?

    Do you own or rent?*

    Do you live in*

    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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    • Home
    • About Us
    • Spay Neuter Assistance Program
    • Pet ID Tags
    • Assistance
    • Helpful Information
    • Donate
    • Free Ways to Help
    • Volunteer
    • Spay/Neuter Magnets
    • Share you story
    • Share Your Story
    • News & Events
    • Contact Us