First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
County*
Email*
Home Phone*
Cell Phone
Are you interested in a specific pet? If so, which one? Choose an animal: Belle Betty Blitzen Boo Boudreau Castle Dallas Dalton Dolly +3 Domino Flynn Georgie Jesse k1 Mac Maisie +5 Marble Miss Tilly Missy Murphy Nora +5 Olive Oreo Oriole Patches Possum Prince Sara Shasta Shelly Stanley Tigger Trinity Trouble Truffles Willow
How did you hear about us?*
Why are you interested in adopting a pet at this time?*
Have you ever lost or given up a pet? If yes, please explain:*
Do you own or rent your home?* Choose one: Rent Own
If you rent, please enter your landlord's name and phone number and let them know we check for their approval:
In what type of home do you live?* Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing
If you have a yard, is it fenced? Please explain and describe:*
How many people reside in your household? Please list ages and relationships:*
Do you have other pets? If so, please explain how many and what type?*
If you have pets, and any are not neutered or up to date with vaccinations, please explain:*
Will the animal be kept inside or outside? * Choose one: Inside Only Outside Only Inside and Outside
For cats you are considering to adopt: Are you planning to declaw? Choose one: Yes No
Where will the animal be kept when you are home?*
Where will the animal sleep?*
How much time will the pet spend alone; and where/how will it be kept when unattended?*
Who in the household will be responsible for the financial and physical care of the pet? Please explain:*
Please list your Veterinarian's name and phone number:*
If you do not currently have a veterinarian, who would you prefer to use if necessary (name and phone number):
Please list two (or more) references - at least one reference who is not a spouse/partner or family member - with their current contact information:*