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ADOPTION APPLICATION Name - First _______________ Middle______________________________ Last_______________________ Address City _________________________ State _______________ Zip _____________ Home Phone Number Work Phone Number_____________ Employer/ Supervisors Name - __________________________________________________ If you attend school, which one?________________________________________________ Year/Grade What do you live in? ",,' House (Do you? Rent or Own Apartment Land1ord's Name Phone Number Condo ___ Mobile Home ____ Dorm _____ with Parents ____Other Animal you are interested in adopting a _______ Dog _____ Cat Name/ID Number_____________________________________ What kinds of pet( s) do you currently have? ,_____________._______When was their last veterinary appointment? ________________ Your Veterinarian's name _______________________________ Phone Number ________________________________________ Are your pet(s) spayed and/or neutered? ____Yes ____No Are your pet(s) vaccinations up to date? ____Yes ____No Are you willing to supervise your new animal with your current pet(s) for at least two weeks before leaving them alone together? ____ Yes____ No Do your pet(s) live? ____ Inside Outside If outside, describe type of shelter pet( s) have: If you adopt a pet, where will it live?________________________ .- How will your pet be exercised? ____________________________________ Have you had other pet(s)? ______ Yes ____ No If yes, what kind? WeretheyJP3yedlneutered? ___Yes____ No Were they vaccinated? ___Yes____ No Reason you no longer have the pet(s)_____________________________________________ Have you ever adopted from an aninIal shelter? _____ Yes ___ No If yes, explain whyHave you ever turned your pet(s) in to an animal shelter?____ Yes____ No If yes, explain why Do you travel frequently? ___ Yes ___ No I f so who will take care of your pet(s) when you are away?How many hours a day will your pet(s) be alone? 'Where will your pet be when it is alone? How many people live in your household? Adult ____ Children____ Ages of Children ______ Are you prepared to supervise your pet( s) with your children? _____yes________no Is anyone in the household allergic to animals?___ Yes ___No
allergic to and how severe their allergy is: _______________________________________ Tell us why you would like to adopt this pet?
____________________________________ How will this pet be used? ___ Companion Animal____ Gift _____ Hunting ____ Watchdog _____Protection _____ Companion for another pet ___Other ( explain)______________________________________________________________________ Are you familiar with the pet responsibility laws in your area?______Yes ___ No , What type of identification will you place on your pet?I t may take a month or longer for your pet to adjust to its new home.Are you prepared to allow this much time? ____ Yes ____ No How will you handle the following inappropriate behaviors? Barking Clawing____________________________________________________ Jumping ,Scratching__________________________________________________ Chewing Litterbox problems Digging_____________________________________ How will you housetrain your new pet? ___________________________________ Dogs and cats can live longer than 15 years. Are you willing to take on
such a responsibility? Please list two personal references (persons NOT related to you)
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