No applicant owning an intact animal will be considered. Exceptions would be a certification from a veterinarian saying the animal is not healthy enough to be altered, or the animal is either being shown or is a finished champion under the age of seven. (written proof to this effect is required.)

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Phone *

Secondary Phone *

Email *

Occupation *

Date of Birth *

Must be 21 years of age to adopt

Please note: Applicants that pass the veterinarian and personal reference check will be requested to furnish their driver's license number. The information will be kept confidential with the exception of law enforcement/background check to determine if the applicant has any record of abuse or neglect toward any animal left in their care.

What type of pet are you looking to adopt? *

Dog
Cat

What type of home do you live in? *

If other, please explain. *

Do you own or rent your home? *

Own
Rent
Other

If other, please explain. *

If you rent your home, does your landlord allow pets? *

Yes
No

Landlord's Name *

First

Last

Landlord's Phone *

Do you have a fenced yard? *

Yes
No

If no, what arrangements will you have for the dog’s exercise and toilet duties? *

What type of shelter do you have for the dog when they are outdoors? *

Are you married? *

Yes
No

Does your partner/spouse know of and approve of the animal? *

Yes
No

Do you have any children? *

Yes
No

Please list your child/children's age(s). *

Are you or any family members allergic to animals? *

Yes
No

Are there any other pets in the household? *

Yes
No

Please list all other animals in household. Include breed, age, sex *

Are your animals spayed/neutered? *

Yes
No

Do you currently have a veterinarian? *

Yes
No

Veterinarian's Name *

Veterinarian's Address *

Address Line 1

Address Line 2

City

State

Zip Code

Veterinarian's Phone *

How many hours on the average will this animal spend alone at your home? *

Where will the animal stay while you are away? *

Where will the animal sleep? *

Have you previously owned a pet? *

Yes
No

If yes, describe the last animal you owned and what happened to it. *

Are you committed to caring for an animal for its lifetime? *

Yes
No

Will you keep the pet up to date on all vaccinations, heartworm prevention and flea control? *

Yes
No

Do you consider yourself financially stable enough to provide proper diet and medical care, including emergency treatment if needed? *

Yes
No

Tell us anything else about your family you’d like us to know.

Personal reference (please use someone other than immediate family). *

We Reserve the Right to Refuse an Applicant

*

What is 4+4?

Pet Adoption

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