Which Animal? *
Relationship to Applicant: *
Other Adults/Kids in Residence and their Age: *
Home Phone
Cell Phone *
Email *
Employer's Phone Number *
Position: *
Do you Rent or Own your Home: * Rent Own
If you rent, do you have your landlord's (homeowners) permission to have a dog/cat? * Yes No
Landlord's Phone Number *
What are your primary reasons for wanting to adopt/foster an animal: *
Does anyone in your home have allergies? * Yes No
If yes, please describe:
Do you have pets now? * Yes No
If Yes, how many? Please list all pet(s) you & co-applicant own, currently & in the past 5 years. Include Type, Breed, Sex, Age, Spayed or Neutered and where it is now *
Are the pet(s) vaccinations current? * Yes No
If not, why?
Are any rooms of the house off limits: * Yes No
If yes, which room(s):
Does your current pet have any temperament/aggression issues? * Yes No N/A
If yes, please describe:
Have your pets been tested yearly for heartworms? * Yes No N/A
Are your pets on a monthly heartworm preventative * Yes No N/A
If Yes, What Brand:
Have you ever allowed a pet to breed? * Yes No N/A
Is anyone at home during the day? * Yes No N/A
If yes, Who is Home During the Day? *
Where will the animal stay when he/she is home alone? Be as specific as possible: (i.e., run of house, a specific room, a crate, etc.) *
When will the animal be indoors? *
When will the animal be outdoors? *
Where will the animal sleep at night? *
Who will care for the animal if you go on vacation? *
If you move, what will you do with the animal? *
What is your hurricane evacuation plan? *
Do you have a fenced yard? * Yes No
If no, how do intend to exercise the animal? *
Do you have a doggie/kitty door? * Yes No
If other, describe:
Veterinarian Phone Number *
Other Veterinarian's used in the past 5 years: (Name, Number, Address)
How would you discipline the animal if he/she misbehaved? *
If Other, Explain (animal training)
Would you consider an older animal: * Yes No Maybe
Would you consider an animal with health problems? * Yes No Maybe
Animal Gender preference: * Female Male No Preference
Are you willing to keep the animal for its entire life knowing the above? * Yes No
Food & Veterinary costs in the case of illness or accident can be very costly, are you prepared to pay these costs in the event your pet requires extra care? * Yes No
Some animals require grooming, are you prepared to provide this grooming if at an additional cost? * Yes No
(1) Reference Phone Number: *
(1) Reference Known How Long: *
(2) Reference Phone Number *
(2) Reference Known How Long: *
(3) Reference Phone Number: *
(3) Reference Known How Long: *
How did you hear about us? *