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Please check here if you have read and understand the above statement.
Email Address (required so we can get back to you)  
Name of pet(s) you are interested in adopting (required) A value is required.
First & Last Name (required) A value is required.
Address (required) A value is required.
City (required) A value is required.
State (required) A value is required.
Zip (required) A value is required.Invalid format.
Home Phone (required) A value is required.
Cell Phone
Work Phone
Driver's License #
Please Fill in blanks
Do you live in a (please choose one)
How long have you lived at the above address?
Do you own or rent?
Does your lease allow pets?
Any restrictions? If so what are they?
Have you paid your pet fee/deposit?

Landlord's name & phone number.

Your previous address.
Are you currently employed?
If employed, where?

INCLUDING YOURSELF, please list the Age, Gender, & Relation of ALL the people living in your household (also include any others who spend a majority of their time at your house).

Do you live with your parents?
If so, are they in agreement with this adoption?
Do you expect any lifestyle changes in the next 2 years? (moving, marriage, new baby, caring for elderly relative)
Does any member of your household have pet allergies?

Do you or anyone else smoke inside the home?

Have you ever adopted a pet from the Pet Placement Center or another rescue organization?
If yes, which organization(s)?
How long ago?
Where are the pet(s) now?
Pre-adoption or follow-up home visits may be required. Would you object to home visits?
If you answered yes to the above question, please explain?
Pet History - Dogs
Do you currently own any dogs?

Please list the breed/age/gender of all your dogs:

Is/Are your dog(s) spayed or neutered?  If not, please explain:
Is/Are your dog(s) up to date on vaccines?
Are you familiar with heartworm disease in dogs?

What brand of preventative do you currently use or plan to use?

Where do your dogs stay during the day?

Where do your dog(s) stay at night?

Besides what is listed above, how many other dogs have you had in the past 5 years? (required)

A value is required.
What happened to the dog(s)?
Has a dog died on your premises of Parvo, Distemper or any other unknown causes in the past 3 months?
Pet History - Cats
Do you currently own any cats?

Please list the age/gender of all your cats:

Is/Are your cat(s) de-clawed?

Is/Are your cat(s) spayed or neutered? If not, please explain:

Is/Are your cat(s) up to date on vaccines?
Where do your cats stay during the day?
Where do your cats stay at night?

Besides what is listed above, how many other cats have you had in the past 5 years? (required)

A value is required.
What happened to the cats?
Has a cat died on your premises of Feline Distemper, Leukemia, FIV or any other unknown causes in the past 3 months?
Do you own any other type of pet(s)?

If yes, what kind(s)?

Please list the name/phone # of the vet clinic you have used for your current pets AND the vet you plan to use if different than the first? (required)

A value is required.
If you are adopting a dog, how do you plan to house train it?
Do you need any suggestions for training?
If scratching became a problem, would you consider de-clawing your cat?
How do you plan to handle scratching or other destructive behaviors?
Where will this pet live (click all that apply)? (required)
Is your yard fenced (click all that apply). (required)
What type of fence do you have?
How high is your fence?
Do you have a pet door? (required) Please select an item.
Is there a dog house?
Do you plan to have this pet spayed or neutered?
If you answered no to the above question, please explain?
Will an adult be home during the day?
Who will be responsible for the new pet?
Why do you want to adopt a new pet (check all that apply).
What would you do with this pet if you have to move from your current home?
What do you plan to do with this pet when you go on vacation?
What would you do with this pet if your current relationship with your roommate, spouse, or significant other should change?
Who would become responsible for your pet should you become unable to care for it due to illness or death? Name A value is required.
Address A value is required.
City/State/Zip A value is required.
I, the undersigned, do certify that the above information is true and accurate. If the adoption I am applying for is approved, I promise to care for the animal to the best of my ability and abide by all state and city laws concerning animals. I understand that abuse, neglect or failure to comply with any of the provisions of the adoption or to fail to hold true to information given in the application will result in removal of the adopted animal from my custody.
Signature A value is required. Date A value is required.
If you are a renter, please understand that we will contact landlords, property owners or apartment managers before approving any adoptions. We will also check with partents with whom you will live before approving any adoptions. This cuts down on the number of adopted pets having to be returned when landlords or parents say no!
Please check your email account as we will be contacting you if we have further questions. Please give us at least 48 hours to respond to your application. Thank you for looking to adopt a shelter pet!
 
 
Pet Placement Center Adoption Questionnaire
Pet ownership is a major responsibility and should not be taken lightly. To assist our efforts to place our animals in permanent, responsible homes, and at the same time match you with a pet that is suitable for you and your lifestyle, this questionnaire must be completed by anyone interested in adopting a pet. WE RESERVE THE RIGHT TO DENY ADOPTIONS FOR ANY REASON.
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