Name *
Name
Address
Address
Phone *
Phone
Email Address *
Employer *
How long at job? *
If Co-Applicant, please provide additional info.
Co-Applicant Name, Address, Phone Number, Email, Employer, and How long at job?
If Yes, please provide name.
What behaviors would you find unacceptable, and how would you handle them?
Why is this a good time for you to adopt a pet? *
Please tell us about your lifestyle and the type of pet you think would be the perfect match for you and your family. *
Who will be the primary caretaker of the pet? *
What would happen to your pet if you had to move? *
If something were to happen to you, who would take care of your pet(s)? *
How much money are you prepared to spend for the care of your pet each year? *
Please provide the number of adults in your household & their ages. *
Please provide the number of children in your household & their ages. *
If you rent, please provide your landlord's name and number.
How long have you been at your current residence? *
< 1 yr
1-4 yrs
5+ yrs
Who will take care of your pet when you go away overnight? *
Where will your pet stay when left alone at home? *
Where will your pet sleep at night? *
How many hours per day will your pet be alone? *
<2 hrs
3-6 hrs
7-9 hrs
10+ hrs
How do you plan to exercise your pet? *
If Yes, please provide additional information.
Kind of pet & what happened to them.
If Yes, please provide the name of the society/shelter and the type of pet(s).
If Yes, please provide the name of the society/shelter, the type of pet(s), and the reason for surrender.
If Yes, when did this happen, and please explain the circumstances & outcome.
If Yes, please provide additional info about your current pet(s).
For each pet, please provide: type, name, age, sex, spayed/neutered (Y/N), Date of last shots, how long you've had the pet, where the pet stays (inside/outside/both)
If Yes, please provide additional info about the pet(s).
For each pet, please provide: type, name, age, sex, spayed/neutered (Y/N), Date of last shots, how long you've lived with the pet, where the pet stays (inside/outside/both)
Current Vet: Name & Number
Previous Vet: Name & Number
Please list three people outside of your home as references. *
Include name, phone number, and relationship.
Today's Date *
Today's Date
