JUST ANIMALS SHELTER
“At Just Animals, we’re almost home”
E-MAIL: adopt@justanimalsshelter.org www.JustAnimals.org
Office Use Only To Adopt: Date Received: Approved/Declined
Incomplete Applications Will Not Be Processed
|
***
ADOPTION APPLICATION *** |
Name:_________________________________________________________________ Phone (H): ____________________________
(First) (Last)
Phone (W): ____________________________
Address:
_______________________________________________________________
Phone (Cell): ___________________________
______________________________________________________________________
(City)
(State)
(Zip) EMAIL_________________________________________
Please Check off the Appropriate
Choices throughout this Questionnaire: WE DO NOT ADOPT TO PERSON’S
Under 21
ARE YOU: Married: ______ Single: ______ Roommates: ______
21-40:
______ 41 – 60: ______ 61-80: ______ 81+: ______
YOU ARE CONSIDERING ADOPTING (Name of Animal):____________________________________
|
Male: ______ Female: ______
______
Adult – (over 1 year old) ______
Adolescent – (4 m-1 year)
DOG |
Male: ______ Female:
______ Long-Haired:
______ Short-Haired:
______ Color Preference:
_________________________
______
Adult – (over 1 year old) ______
Adolescent – (4 m-1 year) ______
Kitten – (2-4 months) |
Please Answer ALL questions by
circling or answering in detail where indicated.
1.
The
reason I want a pet is :
______________________________________________________________________________________________________________________________________________________________________________________________________________________________
2.
Is the
pet for your family? YES______ NO_____
3.
Does
your entire family want a pet? YES______ NO_____
4.
Is the
pet a gift? YES______ NO_____
5.
If yes,
who is the gift for?
_________________________________________________________________________________________
6.
Are all
family members aware you are adopting a pet? YES_____ NO______
7.
How
many adults in the household? _______
8.
How
many children in the household?
____________ What are their ages? _________________
9.
Who has
allergies, and to what animals? _____________________________________________________________________________
10.
Whose
Responsibility is the care of this pet?
__________________________________________________________________________
11.
Vet
costs can add up. The average sick call
to a vet is around $250.00? How much
would you be willing and able to pay a vet should your pet become ill? __________________________________________________________________________________________________
12.
My pet
will be kept in:
i.
House___ Garage____ Basement____ Outdoors____ Outdoor Kennel____ Tied Out____
Crate____
13.
Will
your pet be crate trained (dogs only)? YES_____ NO_____
14.
Will
you attend Obedience Classes (dogs only)? YES_____ NO_____
15.
Are you
prepared for chewing, digging, scratching, house training/litterbox accidents,
and other
mischievous behavior? YES_____ NO_____
16.
How
will you reprimand your pet?
__________________________________________________________________________________
__________________________________________________________________________________________________________
17.
It may
take your new pet a month (or longer if other pets are involved) to adjust to
its new home.
How will you handle this?
____________________________________________________________________________________
__________________________________________________________________________________________________________
__________________________________________________________________________________________________________
18.
How did
you hear about us?
_____________________________________________________________________________________
19.
Have
you applied for, or adopted a pet from us or any other shelter before? YES_____ NO_____
20.
Where?:
______________________ When?: ___________________ Name of Pet: ______________
21.
Do you: RENT
or OWN
House____ Townhouse_____ Condo______ Apartment_____ Mobile Home_____ Live with Parents_____
22.
If you
own, do you have a fenced in yard (dogs
only)? YES_____ NO_____
23.
If
renting, are pets allowed? YES_____ NO_____
Deposit Required? YES_____ NO_____
Weight Limit? __________ Lbs.
Name of Complex:
Name of Landlord:
____________________________________________________________________________________________
Landlord’s Phone Number:
______________________________________________________________________________________
24. If you move where pets are not allowed, what
will you do with your pets? __________________________________________________
25.
Animals
presently living in the house (Circle or Fill in Blanks – Each animal gets its own box).
|
Pet Name: _____________ Dog ____ Cat____
Other____ Breed: _________________________________ Age: __________ Indoor____ Outdoor____ Spayed____ Neutered____ Vaccinated? ___________________ On heartworm preventative (dog only)?
________ |
Pet Name: _____________ Dog ____ Cat____
Other____ Breed:
_________________________________ Age: __________ Indoor____ Outdoor____ Spayed____ Neutered____ Vaccinated? ___________________ On heartworm preventative (dog only)?
________ |
|
Pet Name: _____________ Dog ____ Cat____
Other____ Breed:
_________________________________ Age: __________ Indoor____ Outdoor____ Spayed____ Neutered____ Vaccinated? ___________________ On heartworm preventative (dog only)?
________ |
Pet Name: _____________ Dog ____ Cat____
Other____ Breed:
_________________________________ Age: __________ Indoor____ Outdoor____ Spayed____ Neutered____ Vaccinated? ___________________ On heartworm preventative (dog only)?
________ |
26.
Other
than the animals listed above, please indicate additional pets you have owned
in the last 5 years.
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________
_______________________
Were any lost? ______ Hit by a car? ______ Put to sleep? ______Why?________________________________________
27.
Were
any given away?
______________________ To Whom?
______________________________________________________
Why? _____________________________________________________________________________________________________
28.
Who is
your Vet, and where is s/he located?
______________________________________________________________________
__________________________________________________________________________________________________________
Vet Phone #: ______________________________________________________________________
29.
Is this
your first pet? ___________________
30.
|
Hours per day:
___________________________ Position:
________________________________________________ |
Hours per day:
___________________________
Phone Number: ________________________________________ |
31. REFERENCES (non-family
please):
NAME:________________________________________________________________________
RELATIONSHIP:____________________
PHONE:___________________________ EMAIL:_____________________________________________________________________
__
NAME:_____________________________________________ RELATIONSHIP:_____________ _ ______
PHONE:___________________________
EMAIL:_______________________________________ ____
THE INFORMATION
ON THIS QUESTIONNAIRE WILL BE KEPT CONFIDENTIAL.
I CERTIFY THAT THE INFORMATION
PROVIDED IS COMPLETE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I ALSO CERTIFY THAT JUST ANIMAL’S SHELTER HAS
MY PERMISSION TO CONTACT ANY AND ALL OF MY LISTED REFERENCES AS
___________________________________________________________ _________________________________
(Signature)
(Date)
For office use only:
Comments:
_______________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Date:
___________________________
Please have manager print card information
and customer double check numbers:
Credit Card Number (Visa, Master Card or
Discover): ________________________________________________________________________
Expiration date: ___________ V-Code: ______________ Manager’s
Initials: __________
Customer signs after double checking: ________________________________