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I'm considering:

Adopting

Fostering

Date:

Name of animal:

Name of Applicant:

Please include middle initial and any other name variations

Maiden (or Birth) Name if applicable:

Date of birth:

Address:

City:

State:

Zip:

County:

Length of residency at current address:

Email address:

Please re-enter your email address:

Daytime phone number:

Evening or second phone number:

What is the best time to contact you? (please give times):

Number of children in household and ages:

Name(s) and Birth Date(s) of all adults (over the age of 18) in the home (even if temporary):

1. I am looking for a:

puppy

dog

kitten

cat

name of specific animal on adoption page

Breed:

Weight:

Age:

other

2. Is this pet for a gift?

yes

no

3. Reason for wanting a pet

watchdog

companion

barn cat/mouser

breeding

hunting

family pet

guard dog for business

child's pet

companion for other pet

other

4. Would this be an:

inside animal

outside animal

If outdoors, what type of shelter will you provide:

5. Where will this animal sleep?

6. Will you spay or neuter this pet?

yes

no

7. If your pet becomes sick or injured, are you financially able to spend $500.00 or more for veterinary care?

yes

no

8. Are you willing to crate this animal if necessary?

yes

no

9. How many hours a day will your foster pet be home alone?

10. Who will be responsible for caring for the pet on a daily basis?

11. What arrangements will you be making for your pet when you take trips?

12. Which of the following describes your home?

house

apartment

condonminium

farm

mobile home

Other:

13. Do you have a fenced yard?

yes

no

14. If you rent your home, does your landlord allow pets?

yes

no

15. Do you or does anyone in your household have allergies or asthma?

yes

no

16. Have you or any members of your household been convicted of a crime against animals?

yes

no

17. Have you or any members of your household been convicted of a felony?

yes

no

18. Current pets (please describe name, type, size, how many, ages, and where housed):

Name of pet:

Type/breed:

Age:

Inside or outside pet:
inside animal

outside animal


Name of veterinarian:

Vet's phone number:



Type/breed:

Age:

Inside or outside pet:
inside animal

outside animal


Name of veterinarian:

Vet's phone number:



Type/breed:

Age:

Inside or outside pet:
inside animal

outside animal


Name of veterinarian:

Vet's phone number:



Type/breed:

Age:

Inside or outside pet:
inside animal

outside animal


Name of veterinarian:

Vet's phone number:


19. Have you had pets in the past (other than listed above)?

yes

no


Type/breed:

Age:

Inside or outside pet:
inside animal

outside animal


Name of veterinarian:

Vet's phone number:



Type/breed:

Age:

Inside or outside pet:
inside animal

outside animal


Name of veterinarian:

Vet's phone number:



Type/breed:

Age:

Inside or outside pet:
inside animal

outside animal


Name of veterinarian:

Vet's phone number:



Type/breed:

Age:

Inside or outside pet:
inside animal

outside animal


Name of veterinarian:

Vet's phone number:


Personal Reference - name, address & phone number:

What would you do if your cat started urinating outside the litter box?

Additional comments:

By clicking the submission button, I hereby verify that the facts contained herein are true, accurate and complete, to the best of my knowledge and belief.