Pet Adoption Application Please complete and submit the form below Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Address* Occupation*Home Phone*Work PhoneCell PhoneWhat type of pet do you wish to adopt?*DogCatWhat is the name of the animal you are interested in?*Describe the animal you are interested in:*Why do you want to adopt this pet?*What do you think are the most important responsibilities in owning a pet?*How many hours are you away from home including commute time?*Approximately how many hours will your adopted pet be alone each day?*Number of adults in your household and their ages:*Number of children in your household and their ages:*What is your family lifestyle?*Active & BusyCalm & QuiteVaries Day to DayWhat type of dwelling do you live in?*Single Family HomeDuplex/TriplexApartmentCondoMobile HomeHow many years have you lived at your current address?Do you live with anybody else besides immediate family?*NoYesWho else lives with you?*Is this pet a surprise for anyone in your household?*NoYesDoes anyone have allergies to dogs/cats?*NoYesWho will be responsible for the care of this pet?*Are you renting?*NoYesHave you received written permission to have a pet?*NoYesPlease provide the name & phone number of your landlord:*Do you have any other pets currently living with you?*NoYes, dog(s) onlyYes, cat(s) onlyYes, dog(s) and cat(s)Yes, otherWhat type of pet?*Please provide breed, age, sex, altered status and any other info for any other pets currently living with you:*Are your pets up to date on all vaccinations?*NoYesIs your dog/cat on monthly flea preventative?*NoYesIs your dog on monthly heartworm preventative?*NoYesHave you ever adopted a dog/cat from a rescue or shelter?*NoYesWhich shelter?*Have you ever been denied adoption by any rescue or shelter before?*NoYesDo you know why you were denied? Please describe:*Have you ever surrendered an animal to a shelter or given a pet away?*NoYesWhy?*Have you ever had a pet euthanized?*NoYesWhat were the circumstances?*Do you believe in spaying/neutering your pets?*NoYesWhat circumstances would make you give up your new pet or need to find them a new home?*Do you have a fenced yard?*NoYesWhat kind of fence do you have?*Do you plan to crate train your new dog?*NoYesUndecidedAre you willing to housebreak/potty train this dog?*NoYesUndecidedWhen outside, will this dog be supervised?*NoYesDuring the day, where will the dog/cat be kept?*During the night, where will the dog/cat be kept?*If on an extended trip, how do you plan to have your pet taken care of?*What is your vet's name?What is your vet's phone number?What is your vet's address?When was your last visit to the vet & why?*Can you afford routine medical costs or any health issues if they arise now or in the future?*NoYesNot SureIf needed, are you willing to have a home check before adoption?*NoYesNot SurePlease provide the name and phone number of at least 3 personal references:*EmailThis field is for validation purposes and should be left unchanged.