Pet Adoption Pet Adoption Application For which pet are you applying?*Personal InformationName* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Cell Phone*Work PhoneEmail* Employer InformationName of Employer*Employer Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Spouse/Partner/Roommate InformationSpouse/Partner/Roommate Name First Last Work PhoneCell PhonePet living conditions informationWhat are the reasons for adopting a pet?*Where will your new pet spend most of it's time?* Yard House Basement Kennel Other Area Other area description*What percent of time will your new pet spend in the Yard?*Please enter a number from 0 to 100.What percent of time will your new pet spend in the House?*Please enter a number from 0 to 100.What percent of time will your new pet spend in the Basement?*Please enter a number from 0 to 100.What percent of time will your new pet spend in a Kennel?*Please enter a number from 0 to 100.What percent of time will your new pet spend in Other area?*Please enter a number from 0 to 100.Do you have a fenced yard?*YesNoDo you plan to chain or tie this pet in the yard?*YesNoWill you have a pet door?*YesNoWhere will the pet be kept while you are at work or away from home?*Where will the pet sleep at night?*Discipline and CharacteristicsHow do you deal with house breaking issues?*How will you deal with behavioral issues?*What qualities are you looking for in a pet that you would like to adopt? Be very specific so we can make the best possible match? (couch potato, very active, etc)*What do you expect to be the hardest part about adopting a animal, and how do you plan to address it?*Current PetsDo you currently have pets?*YesNoWhat type of pets do you have Dog Cat Other What other pets do you have?*Who is your regular veterinarian?*What were the dates of your current pets vaccinations?*Are your current pets spayed or neutered?*YesNoAre your current dogs tested for heart worm disease and placed on prevention?*YesNoWhat specific heart worm prevention products is your dog on?*Are your current cats tested for Feline Leukemia?*YesNoI confirm that all the information in this application is correct and complete to the best of my knowledge and understanding. Information will be weighed and the best match for the animals will be considered and placed in the most appropriate home.To sign form type in your name.*Date Date Format: MM slash DD slash YYYY
