Adoption Application Name(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Email(Required) Are you over the age of 21?(Required) Yes No Household InformationPlease provide the following information for all adults in the home: Full Name, Relationship to you, Phone number(Required) Please provide employment information for all adults in the home: Employer (or retired, self-employed, homemaker)(Required) Name(s) and age(s) of child(ren) in your home or who frequently visit, if none mark N/A:(Required) Do you live in a:(Required) House Apartment Condo Mobile Home Dorm Farm Parent's House Other Do you own or rent your home? (If someone else is listed as owner of the home we consider you a renter, even if it is your parent that owns the home.)(Required) Own Rent If you rent, have you spoken to your landlord to confirm that you can have a new pet? (If yes, please provide the following questions about the landlord. If you have not spoken to your landlord about adopting this animal, please do not turn in the application until you have done so.)(Required)YesNoDoes your landlord have any specific requirements or limitations to the pet you can adopt, please explain?(Required) Landlord’s Name:(Required) First Last Landlord’s Phone Number:(Required)Are all the members of your household in agreement with this adoption? If no, please explain any concerns.(Required) Do you have a fenced in yard? Please note, a fence is not typically required for adoption purposes, but as some animals are prone to chasing wildlife or are escape artists, we like to understand your home set-up. Yes No If yes, what material is the fence made of and how tall is it?(Required) Do any of your family members have pet allergies? If Yes, please explain who and their allergies. Mark N/A if there are no pet allergies.(Required) Personal ReferencesPlease provide the following information for two Personal References. These references cannot live the in the same house as you. One reference can be related to you. The second reference cannot be related to you or your other reference (for example, this reference could be a friend or coworker). Do not list your veterinarian as a personal reference.Reference 1 Name(Required) First Last Reference 1 Phone(Required)Relationship to you(Required) Reference 2 Name(Required) First Last Reference 2 Phone(Required)Relationship to you(Required) Current and Previous PetsHave you had any other pets in the past 5 years?(Required) Yes No, I have not had pets in the past 5 years No, I am a new pet owner Please provide the following information for pets you currently have or have had in at least the past five years. To adopt from our organization, all current pets must be spayed/neutered and up-to-date on vaccinations unless prohibited medically. My Pets Pet Name Cat/Dog (Breed) Age Sex Actions Edit Delete There are no Pets. Add Pet Maximum number of pets reached. If there is any additional information you would like us to know about your past or current pets? Please share that in this space.Current Veterinary Clinic Name, N/A if you do not have a current veterinarian:(Required) Current Veterinary Clinic Phone Number:Previous Veterinarian Information if your current vet does not have all the information on your pets: Have you contacted your veterinary to give them permission to share information with us about your current or previous pets? If you have not, please contact your veterinarian before turning in the application so we will be able to process your application.(Required) Yes No Information About the Animal You are Interested InName of Animal you want to Adopt (Please mark Undecided if still deciding or need suggestions)(Required) Why did you choose this animal (Please mark Undecided or N/A if no animal is listed above)?(Required) Please select the type of animal you are applying for(Required) Cat Dog Is there a specific breed of cat or dog you are looking for, if so why? Tell us about your ideal pet, what traits are you looking for in your new pet? Sex(Required) Male Female No Preference Activity Level(Required) Low Medium High No Preference Age(Required) 8-16 weeks 4-12 months 1-3 years Older No preference Adult Size(Required) 4-20 lbs 21-45 lbs 46-70 lbs 71+ lbs No Preference Coat(Required) Short Medium Long No Preference Do you need a dog/cat that will be adaptable to any of these considerations?(Required) Children Other Pets Empty House During Night/Day Busy Household Other None If other, what situation do we need to be aware of? Are you willing to consider an animal with “special needs” (special diet, disabled, shyness, etc)?(Required) Yes No Are you willing to allow us to recommend an animal that may be a better fit if the one you chose is not a good match for your situation?(Required) Yes No Why are you looking to adopt (choose all that apply)(Required) Companion for self Companion for children Companion for another pet Farm Guardian Emotional Support Animal Gift for someone A mouser A hunter To breed Do you plan to exercise the animal outdoors? If so, how often(Required) How long will the animal be home alone most days?(Required) Where will the animal be kept when no one is home?(Required) Do you plan to declaw?(Required) Yes No If yes, would the surgery be performed with(Required) Blade Laser Have you researched the procedure, recovery, and possible complications?(Required) Yes No If applying for a cat, please explain how you will train your new pet toStay off furniture/tables(Required) Not chew on plants or other items(Required) Not scratch on furniture(Required) Explain what you will do if your new cat urinates outside the litter pan, on wall or carpet (if adopting a cat).(Required) How will you house train a dog or puppy?(Required) How will you train your dog not to chew on shoes and other personal items?(Required) What situation do you foresee that would cause you to return an animal that you have adopted? Please answer honestly, it helps us match you to the right animal. (for example, doesn’t get along with current pets, housetraining problems or cat urination problems, aggression, separation anxiety, moving to a new home)(Required) Are you willing and able to invest money and time in training, feeding, and/or providing necessary veterinarian expenses when they arise?(Required) Yes No I certify that the information entered on this application is true. I recognize that any misrepresentation of facts will result in my losing the privilege of adopting an animal. Enter your name and date below(Required) Is there anything additional you would like to tell us about your application?