Please enable JavaScript in your browser to complete this form.What is the name of the pet you're interested in adopting? *Name *FirstLastAre you 21 years old or older? *YesNoPhone (cell) *Phone (secondary number)Email *Your occupation *Address *Street AddressCity *State *Zip *Do other people live in this house with you? *SpouseSignificant otherRoommateChildrenOther family memberI live aloneName of spouse/significant other/roommate/other family member *Answer "NA" (Not applicable) if you have no spouse/significant other/roommate/other family memberWho will be primarily be responsible for the pet's care? *Do all adults in your household know you plan to adopt? *YesNoAre there children in the home or that visit frequently? *YesNoWhat age(s) are the children living in this house? *What age(s) are the children that visit frequently?I am applying to adopt a: *DogCatBarn CatOtherIf you selected "Cat" above, do you plan on declawing this cat? *Who is the pet being adopted for? *A companion for myselfSpouseChildren want oneHousehold family petFor my other pet he/she is lonely while I'm awayAs a gift for someone outside my homeOtherIf you chose "Other" above, please explain.Your type of residence *ApartmentCondo/DuplexTrailerSingle-family homeOtherDo you own or rent? *Own/buyingRentLiving with parents/familyOtherHow long have you lived at your current residence? *Do you currently have a pet? Yes or No *If yes, please answer a few questions about pets you currently have. If you don't currently have any pets, you can skip this section.List animals currently living in your household. (Breed, sex, age for each animal)If you currently have a dog, does it like/get along with: *Other dogsCatsDoes not like other animalsUnknownIf your dog does not like other animals, please explain:If you currently have a cat, does it like/get along with: *Other catsDogsDoes not like other animalsUnknownIf your cat does not like other animals, please explain:Is your pet current on vaccines? *YesNoUnknownIs your dog(s) on year-round heartworm preventive? *YesNoI can't afford to keep my dog on heartworm preventionI do not own a dogCan you give me more info about heartworm preventive?Are all cats and/or dogs in your house spayed or neutered? *Yes ALL are spayed/neuteredNo, none are spayed/neuteredSome are, some aren'tIf any of your current cats and/or dogs are NOT spayed/neutered, please explain why not.Do you own additional pets beyond the ones listed above? if so, please list any additional pets, including temperament.Pet history as an adult (5yr span). Pets that I do not currently own. *I have owned a pet in the past 5 years. Please provide more information in the next few questions.I have NOT owned a pet in the last five years. Skip next few questions.Dogs I've owned in the past 5 years, that I do not currently own.Please list each dog you've owned in the last 5 years. What happened to this dog? if they have passed away, please list age and cause of death, if known.Cats I've owned in the past 5 years, that I do not currently own.Please list each cat you've owned in the last 5 years. What happened to this cat? if they have passed away, please list age and cause of death, if known.Other pets I've owned in the past 5 years, that I do not currently own.Please list each other pet you've owned in the last 5 years. What happened to this pet? if they have passed away, please list age and cause of death, if known.Pet living situation. Will the pet you are adopting be: *Indoor onlyMostly indoorMostly outsideOutside onlyOtherThis pet's outdoor space will be: *Inside only catFenced yardUnfenced yardOpen acreageNo yard - pet will go outside on leashOutside dog run/kennelOtherIf you chose other above, please explain:What type of fence do you have? Stockade, Chain link, picket, etc. *Do you currently have a veterinarian? *Yes (Please fill out information below)No, I do not have a veterinarian.I would like a referral for a veterinarian.Name of current/last veterinarian.Veterinarian phone numberPersonal reference *Please list your reference's name, email address and at least one phone number.If the pet becomes destructive, what would you do? *What are you looking for in a pet? Activity level preference? Temperament? *Anything else you'd like us to know?Please type your name. This serves as your signature, agreeing that you have provided accurate information to the best of your ability. *Submit Go back to adopt page
