Type of Residence

Own	Rent
House	Townhome	Apartment

Landlord's Information:
Name:
Phone:

Type of companion animal you are seeking:
Puppy	Adult Dog
Kitten	Adult Cat

Large, Medium or Small Breed. Specific Name(s) of Dog or Cat: How many people in household and ages:
Total:
Adults:
Children:

Why are you interested in adopting? Check all that apply:

Companion for Self For Breeding For Protection Replace Previous Pet Other

Companion for Family Gift For a Child Companion for Other  Pet

Please specify other:

Is this your first pet? Yes     No

If no, please list previous pets, duration you cared for the pet and when he/she was deceased:

Do you currently have other pets? Yes       No

If yes, please list current pets (name, size & age) and how long you have had them:

How do you plan to introduce the new pet to the household?

How will you handle the following situations? Please answer all questions completely.
1. Family allergy to pet:

2. Pet Medical Expenses
(unexpected emergencies and diagnosed medical conditions)

3. Moving

Sometimes animals do not adjust to their new environments well.  Are you prepared to spend several weeks, perhaps even months, waiting for your new pet to adjust to a new environment?

Yes       No

Please provide your  Veterinarian Information for past or current pets:  REQUIRED

How much money do you anticipate  investing in your pet's veterinarian medical expenses annually?

What annual vaccines does your current pet or will your future pet receive and how often?

Will your newly intended pet be an indoor or outdoor pet?
Indoor      Outdoor

What is the longest duration you will leave your pet outdoors while unattended?

Does your residence have any of the following (check all that apply:)
Yard   Fence   Dog Run   Dog Door

Please specify type and height of fence:

Where will your pet be kept (free roam of house? crate? outdoors?)

At night:
Day time:

How many hours a day do you spend at home?  Please indicate work schedules of all adults in household 

What brand/ type of food do you plan on feeding your pet?

If the animal you adopt is not already spayed or neutered,  do you plan on having him/ her spayed or neutered?

Yes       No

Do you plan on having your new pet enrolled in obedience training, if so, where?

Who will be the primary caregiver for the newly adopted animal?

Does anyone in the household have any known animal allergies, please specify:

How did you hear about Animal House Shelter?

Have you ever turned an animal into a shelter, if yes, why?

Animals are not perfect, and occasionally situations arise that were not planned for.  Please explain in detail how you would handle  each of the following situations.  Applications will not be considered complete  if these are not answered.   Consider that all of the following behaviors could occur while you are home, but also when you are not. 

"Training" is what would need to be done but please let us know what specific techniques you would use to train.

Jumping on furniture/ counter tops/ tables  

Scratching/ biting/ ripping furniture

Chewing on plants/ garbage/ other

Barking

Play Biting

How will you correct your pet if it does the following:

Urinates/ defecates inside the house

Keeps you awake at night

Sheds excessively

Ruins an expensive article

Please provide three references (not related to you) and their phone numbers:

I certify that the information I have provided is accurate and honest.

Name:
Date: