Name
Address
CityState Zip Code
Home Phone Work Phone
e-mail address

ANIMAL REQUESTED

Animal name
Breed
Age
male female

HOUSEHOLD INFORMATION

Please include the name, age, and relationship to you of all members of your household

ANIMAL OWNERSHIP HISTORY (5 years)

Please let us know what animals you have owned in the past. Include breed, age, sex, whether they were spayed/neutered, whether they were indoor/outdoor animals, and what has become of the animal.

GENERAL INFORMATION

What type of housing do you live in? House Apartment Trailer Condominium Shed Box None Yard Size: Large Medium Small None
Do you rent? Yes No
If so, do you have your landlord's permission to keep a pet? Yes No
Landlord's phone number
Where will the animal spend the day? Loose Indoors Crate Basement Garage Fenced Yard Loose Outdoors Tied Up Outdoors
Where will the animal spend the night? Loose Indoors Crate Basement Garage Fenced Yard Loose Outdoors Tied Up Outdoors
How many hours each day will the animal be alone? Less than 2 2 to 4 4 to 6 6 to 8 greather than 8
Will you provide veterinary care if the animal falls ill? Yes No
Name of Veterinarian or Clinic

What is your prefered method of correcting poor behavior?

Why do you want a pet?

What does your significant other (spouse, roommate, partner) feel about getting a new pet?

Do you feel that taking the responsibility of a pet is a lifetime commitment? Yes No
If you move, will you take the pet with you? Yes No
What Type Of Animal Are You Interested In? Dog Cat

DOG INFORMATION
Fill out this section only if you wish to adopt a dog

How will your dog get adequate exercise? Walk Daily Fenced Yard Kennel Run Roam freely Chased by Animal Control
Fence height Less than 4 feet 4 feet 5 feet 6 feet Greater than 6 feet Fence Type Solid Chain Link Other Kennel Size None Large Medium Small
Do you have a dog run? Yes No
Dog house size None Small Medium Large Sleep location Indoors Outdoors
Misc Information (household hazards, etc)

CAT INFORMATION
Fill out this section only if you wish to adopt a cat

Will the cat be an indoor or outdoor cat? indoor only outdoor only indoor/outdoor
What methods do you intend to use to keep your furniture and drapes intact?
Misc Information (household hazards, etc)