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Date:
*
What animal are you interested in?
*
What animal are you interested in?
APPLICANT INFORMATION
All fields marked with an
*
must be completed in order for your application to be submitted.
Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Complete your full address
Email Address:
*
*
Indicates required field
Primary Contact Number
*
Put Phone Number in 10 Digit Format Example 313 123 4567
Other Number
*
Work Number
*
Primary Phone Type
*
Cell
Home
Other
Other Phone Type
*
Cell
Home
Spouse's Phone
Other
Are you over the age of 21 years old?
*
Yes
No
Are you 21 years of age, yes or no?
EMPLOYMENT INFORMATION
Status:
*
Employed
Retired
Unemployed with benefits
Unemployed with no benefits
Status
*
Full-time
Part-Time
Other
N.A.
Employer Name:
*
Employer City & State
*
RESIDENCE INFORMATION
Do you:
*
Own
Rent
Lease
How many adults live in your home?
*
How many adults live in your home?
How many children live in your home? Please list there ages:
*
How many children live in your home? Please list there ages:
What type of home?
*
Single Family Dwelling
Duplex
Condo
Apartment
Mobile Home
What type of home? Select one of the following.
How long have you lived in at this residence?
*
How long have you lived at this residence?
How long do you plan on living in your home?
*
How long do you plan on living in your home?
RENTERS INFORMATION
The following 3 fields are REQUIRED for RENTERS.
Landlord Name:
*
If you rent please list the name and phone number for your landlord:
Address
*
Line 1
Line 2
City
State
Zip Code
Country
If you rent are you willing to get a letter from you landloard stating you are allowed to have this pet?
*
Yes
No
N/A
If you rent are you willing to get a letter from you landloard stating you are allowed to have this pet?
HOME ENVIRONMENT
How is your yard secured?
*
Cyclone Fencing
Privacy Fencing
Electronics Fence
No Fencing
Home Atomsphere
*
Grand Centeral Station
Some Activity
Zen Garden
If your yard is not fenced in how do you plan on containing,exercising and providing potty breaks your pet?
*
If your yard is not fenced in how do you plan on containing your pet?
Where will the pet primarily stay?
*
Where will the pet primarily stay?
What will you do with your pet when your not home?
*
What will you do with your pet when your not home?
CURRENT PET INFORMATION
Please complete all information for each pet currently residing in your household. If you have more animals than the space provided list each additional animal in the comments section at the bottom of this application.
Pets Name:
*
Current Pets: Please list name, breed, age, if they are spayed/neutered, and how long you have had them:
Gender:
*
Male
Female
Altered:
*
Spayed
Neutered
Not Altered
Species:
*
Canine
Feline
Current on vaccines:
*
Yes
No
Comments:
*
Age:
*
Length owned:
*
Breed:
*
Temperament(check all that apply):
*
Dominant
Submissive
High Energy
Laid Back
Pets Name:
*
Gender:
*
Male
Female
Spayed/Neutered:
*
Yes
No
Species:
*
Canine
Feline
Current on vaccines:
*
Yes
No
Comments:
*
Age:
*
Breed:
*
Length owned:
*
Temperament(check all that apply):
*
Dominant
Submissive
High Energy
Laid Back
Pets Name:
*
Sex:
*
Male
Female
Spayed/Neutered:
*
Yes
No
Species:
*
Canine
Feline
Current on vaccines:
*
Yes
No
Comments:
*
Age:
*
Length Owned:
*
Breed:
*
Temperament:
*
Dominant
Submissive
High Energy
Laid Back
Please list the animals you have had in the last 10 yrs that have expired. Please list names, breed, ages, if they were spayed or neutered, how long you had them and the reason you no longer have them:
*
Please list the animals you have had in the last 10 yrs: Please list names, breed, ages, if they were spayed or neutered, how long you had them and the reason you no longer have them:
VETERINARIAN INFORMATION
All fields marked with an
*
must be completed in order for your application to be submitted.
Current Veterinarian Name:
*
City & State
*
Phone Number
*
Please give the name and phone number of all veterinarian(s) for the past TEN YEARS:
*
Please give the name and phone number of all veterinarian(s) for the past TEN YEARS and note which is your current veterinarian:
Do you give heartworm preventative?
*
Yes
No
Do you give heartworm preventative?
Are you willing to work with any behavioral issues? (check all that apply, if none please check none):
*
None
Barking
Jumping
Digging
Fear
Leash Training
Anxiety
Resource Guarding
Are you willing to take this animal for a basic obedience class if required?
*
Yes
No
Are you willing to take this animal for a basic obedience class if required?
Are you willing to accept a dog with special needs? (check all that apply, if none please check none):
*
None
Allergies
Blind
Deaf
Skin Issues
Special diet
Deformity
What is the reason you are choosing to adopt?
*
What is the reason you are choosing to adopt or foster?
PERSONAL REFERENCES
Please list the name one of three references you have known for at least 5 years. All fields marked with an * must be completed in order for your application to be submitted.
Name:
*
Phone Number
*
Relationship:
*
Email
*
Name:
*
Phone Number
*
Relationship:
*
Email:
*
Name:
*
Phone Number
*
Additional Comments
*
Relationship:
*
Email:
*
All the above information was answered correctly and honestly, to the best of my knowledge.
*
Yes
No
All the above information was answered correctly and honestly, to the best of my knowledge.
Submit
Home
About Us
Contact Us
ADOPT
Adoptable Animals
Cat Condos
Adoption and Foster Forms
Adopted!
Foster
Donate
Community Outreach
Pet Health Facts
Local Resources
Feral Cats
>
Feral Cat Photo Gallery
Events
Fundraisers
Forms
Would You Like to Volunteer?
Adopter Services
Existing Client Food Order Form
Existing Client Information Updates
Join our mailing list