Adoption Application


Filling out an adoption application does not automatically approve you for adoption.  Follow up questions may be asked based upon your answers, and eligibility will be determined by me using whatever criteria I see fit.

Name of Applicant
Name of Spouse/Partner
Street Address
City, State and Zip
Primary Telephone Number (555)555-5555
Email Address:
Date of Birth (MM/DD/YYYY)
What type of pet are you applying to adopt? (If applying as a foster home, please enter FOSTER here.)
I live in a House
Mobile Home
I ______ my home. Own
If you answered "Other," please explain.
If you rent or otherwise do not own your home, please enter the name and telephone number of your landlord or property managment company. (Required)
If you were to move today, what would you do with your pets?
How many adults are in your household?
How many children are in your household? Please enter 0 if there are none.
Please list all pets currently within your household. Enter "none" if applicable.
Are all of your animals current on veterinary care and vaccinations? Yes
Some of them
Have you ever given a pet away or surrendered a pet to a shelter? Yes
If yes, please explain the circumstances. Include dates for reference. (Required)
Have you or any person in your household ever been convicted of cruelty or neglect of either animals or people? Yes
I am adopting this pet to be Indoor Only
Outdoor Only
Have you owned this type of pet before? Yes
Do you want to breed this animal? Yes
How do you plan to house this animal? Please be specific as to dimensions and components. If you are unsure of requirements, please state that in your answer.
Do you have any questions concerning the care for this animal?
By initialing this box, you do certify and swear that all information included in this application is true to the best of your knowledge and ability.

This form is hosted by a free service which displays an advertisement each time a form is submitted.  I do not endorse or monitor these ads.  This application is hosted by this free service in order to keep costs down.  Thank you for your understanding.

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