| First and Last Name: |
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| Email Address: |
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| What is your age? |
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| What is your telephone number? |
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| Is there a particular pet that you are interested in? Please indicate pets name and/or breed |
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| Co-Applicantʼs Full Name and Age. |
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| Complete Home Address (street/city/state/zip |
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| Type of housing you live in |
Own Single Family Dwelling
Own Condo
Own Mobile Home
Rent
Live with parent
Other
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| Landlordʼs Name and Telephone Number if Renting. |
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| If "other" is checked, please explain. |
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| Previous Address if current address is under 2 years. |
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| Childrenʼs Ages |
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| Please list all members of your household whether they are relatives or not. (name, age, relationship) |
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| Does your home have a yard? |
No
Yes
Completely Fenced In
Locked Entrance
Underground Fence
Probably install a fence in the future
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| Have you owned a pet before? |
No
dog
cat
bird
fish
reptile
small & furry
horse
Several different pets
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| Where are these pet(s) now - List type of pet, how many years you owned them and reason for no longer owning them. |
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| Do you have any pets currently? List type, breed, age, sex and how long your've had this pet |
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| Name of your Vet or prior Vet |
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| Telephone Number of your Vet |
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| What name is the pet under at your Vets office? |
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| Why do you want to bring a new pet into your home? |
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| Is everyone in your household in agreement on adopting a pet? |
No
Yes
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| Where will this pet spend most of its time? |
Inside and Crated
Inside and Free
Outside
Other
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| If other was chosen, please explain. |
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| Is anyone home during the day? |
No
Yes
Sometimes
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| Is there anyone home during the night? |
No
Yes
Sometimes
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| What provisions will be made for your pet when no one is home? |
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| What provisions will be made when you go on vacation? |
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| Are you willing to provide training for your pet (obedience, housetraining) |
No
Yes
Need more information to decide
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| Do you know of a trainer or place that provides training in your area?
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No, please provide me with that information
Yes
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| Are you planning on particular activities with your pet? Please explain. |
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| If you are adopting a dog, will this dog be used as a guard dog? |
No
Yes
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| Have you considered the yearly cost of owning a pet?
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No
Yes
Would like more information on pet costs
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| Under what circumstances would you give up your pet? |
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| Do you have any questions or comments?
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No
Yes
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| If yes was chosen, please indicate your question(s) or comment(s) here. |
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