Professional Documents
Culture Documents
n/a in the box provided. Thank you so much for choosing adoption! These animals deserve it!!
*Household Information*
Name: _________________________________________________
DOB:____________ DL#:_______________St:_____
Address:________________________________________________________________
City:___________________________________St:_______ Zip:________________
Email:___________________________________________________________________
[ ]Other _________________________________________
Do you rent? Yes__ No__ If yes, please provide the following information:
Phone: _________________
Is a pet deposit required? Yes__ No__ Is there a breed restriction? Yes__ No__
If yes: Can proof of deposit be obtained from your landlord? Yes__ No__
*Questionnaire*
Have you ever been convicted or accused of Animal Cruelty/ Neglect? If so, please
explain:________________________________________________________________________________
__________________________________________________________________________
Do you have experience with house training and crate training? Yes__ No__
Have you had experience with a shelter pet and what behavioral issues they may have? Yes__ No__
How many people live in your house over the age of 18? _______ Under 18? _______
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Are you or your spouse a student? Yes__ No__ Full time / Part time
Do you travel frequently? Yes__ No__ If yes, who will care for your pet(s)?
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Does anyone living in your household have allergies to dogs? Yes__ No__
Have you ever given an animal up for adoption/ rehomed/ turned over to animal welfare? Yes__ No__
if yes, why?_______________________________________________________
Have any pets in your home, now or in the past, been diagnosed with an infectious disease? Yes__ No_
Which diseases? (Fel Leuk/ FIP/ FIV/ Heartworms/ Distemper/ Parvo/ Coccidia/ Mange )
Would you use a tie out/chain to keep the animal in the yard? Yes__ No__
Would the dog ride in the back of a truck? Yes__ No__ Is there a camper top on the truck? Yes__ No_
The pet I am adopting will be kept: [ ] Totally Inside [ ] Mostly Inside [ ] Mostly Outside [ ] Totally Outside.
While working, I am gone _______ hours a day and my spouse is gone _________hours.
Please list all cats and dogs you have owned and currently own:
SPAYED/ WHERE IS THE
NAME AGE TYPE OF PET
NEUTERED ANIMAL NOW?
Please explain here if any of your current animals are not spayed or neutered:
_____________________________________________________________
Do your current animals get along with other animals: Yes__ No__
________________________________________________________________________
How will your new pet get exercise? [ ]Daily Walks [ ]Backyard play [ ]Dog Park [ ]Other:______
Number of pets NOT CURRENTLY OWNED, but owned within the last 5 years:
What happened to these pets and why do you not have them anymore?
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*References*
Name:__________________________________________
Name:__________________________________________
*Comments*
If there is something that we did not cover, or you would like to explain further please put all comments/
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I have contacted the potential adopter with the disposition of this application/agreement._______