Which pet are you interested in

Which pet are you interested in?
Why this pet?
Why do you want to adopt a pet?

Your Name:
Age:
Spouse name:
Age:
Address:
City, State, Zip
Home Phone:
Work Phone:
Cell Phone:
Email Address:
Your Occupation:
Employer:
How long employed:
Employer Address:
Employer City, State, Zip:
Employer Phone:
Work schedule/# of hours:
Spouse's Employer:
Do you or anyone in your family smoke?

Home Information:
What type of home do you live in?
If other, please explain:
Do you own or rent?
If you rent, do you have permission to own this pet?
Are there any rules governing this ownership, i.e., mandatory declawing, must be under a certain weight?
If Yes, please explain:
Name of Landlord/Complex:
Landlord / Property Management Address:
Person to contact and phone:
How long at your current address?
If less than 5 years list previous address and length there:
Do you have a fenced in yard?
If Yes, describe type of fencing (height, material type, etc.):

Personal Household Information:
Do you foresee any major life changes in the next 15 years? Example, marriage, children, health concerns, going away to school?
If yes, explain
Number of adults in home:
Number of children and ages:
Do all family members know of your plans to adopt a pet and are they all excited about the prospect?
Do any of your family members have pet allergies?
If you have young children and are not sure if they are allergic, would you mind that the pet just visit your home before any final adoption arrangements are made?

Current and Past Pet Information
List other pets you currently own, species, age, personality

Type of Pet (Dog, Cat, Bird, etc)	Breed	Age	Sex	Personality Type

Are all pets spayed/neutered?
Are any of your pets declawed?
Where do your pets sleep?
Where do your pets stay when they are home alone?
Do you keep a collar and tags on your pets at all times?
Are your pets micro chipped? If so, by whom (microchip company)?
Will you agree to microchip the pet should this adoption be granted?
If you owned pets previously, give details on each and explain why you no longer have them. Be specific, i.e., if died, specify reason, if given away, to whom and why. Include dates of ownership:

Type of Pet (Dog, Cat, Bird, etc)	Breed	When owned:	What happened to this pet?

By checking this box: I certify have answered all of the above questions truthfully and to the best of my ability.

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Have you had a serious behavioral problem with a previous pet?
Did it result in you having to get rid of the pet?
If so, where did the pet go?
Do you know what heartworm disease is and how to prevent it?
If you currently own dogs, which preventative are they on?
What type of flea/tick prevention do you use or plan to use?
How many hours will this pet be home alone on a daily basis?
Will this pet live inside, outside or a combination of both?
Do you have a pet door?
Where will your pet sleep at night?
What do you expect vet care, preventative care, food, grooming and overall care of this pet to cost every year?
Name of veterinarian we can call for a reference:
Address of veterinarian:
Phone Number of veterinarian:
Name of Groomer or other animal care specialist:
Phone number of Groomer or other animal care specialist:
For which of the following reasons would you give up your pet? (please select all that apply)	Moving New Baby Not getting along with children Children lost interest Divorce Increased work hours Allergies Gets too big Not Getting along with other pets Shedding Not Housebroken Behavioral problems Getting out of fence Barking Aggressive Medical problems None Other, Explain:
Are you willing to take this pet, if a dog, to obedience school at your own expense?
Have you brought other pets to obedience school?
If so, which school?
What brand and type of pet food do you intend on feeding your pet?
Do you need to be educated on the best food to feed your pet?
Suppose your pet becomes ill and its’ treatment would cost thousands of dollars ... What would you do?
Would you date or marry someone who doesn’t like your pet?
Have you ever looked at or applied to another rescue group or animal shelter for a pet?
If yes, give name of organization/shelter:
Do you object to an unannounced home visit by a representative from our organization?

References
Please list names, address and phone number of 3 personal references other than relatives:
Reference #1 Name
Reference #1 Address
Reference #1 Phone
Reference #2 Name
Reference #2 Address
Reference #2 Phone
Reference #3 Name
Reference #3 Address
Reference #3 Phone