First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
 - 

Email*

Home Phone

Work Phone
x

Cell Phone

Alt Email

Text/Pager Email

Which animal are you interested in
Choose an animal: Cray Daisy Dalton Diamond Harper Mazie

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Do you own or rent your home*
Choose one: Rent Own

If you rent, have you received the approval of your landlord to have an animal
Choose one: Yes No

If you rent, please enter your landlord's name and phone number

Is your yard fenced*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

What is the height of the fence*

What type of fence*
Choose one: Privacy Chain Link Invisible

Will the animal be kept inside or outside*
Choose one: Inside Only Outside Only Inside and Outside

Where will the animal sleep*

How much time will the animal spend alone during the day*

Where will the animal be kept when you are not home*

Where will the animal be kept when you are home*

For cats only: Are you planning to declaw
Choose one: Yes No

Describe how you will train the pet*

Who in the household will care for the pet*

How many people reside in your household? (Please list adult and children's ages)*

Who is this animal for?*

Do you have other pets? If so, type?*

Have you ever owned a cat or dog?*
Choose one: Yes No

What traits are you looking for in a pet

Have you ever given up a pet? If yes, please explain*

How long have you lived at your present address?*

How many times have you moved in the past 10 years?*

If you have to move, what will happen to the animal?*

Veterinarian's Name and Phone Number*

Why are you interested in adopting a pet at this time*

List at least one reference (who is not a family member)*

I certify that the information entered on this applicant is true. Enter your name and date*