TX Driver's License (or Texas ID) number:*
What is your age?*
Which animal are you interested in?*
Choose an animal:
Jessie (must be adopted with Lilly and Lilly)
Lilly (must be adopted with Jessie and Jessie)
Miss Kitty 2
Do we have your permission to do a home visit?*
Do you own or rent your home or live with a family member*
Live with Family Member
If you rent, have you received the approval of your landlord to have an animal
In what type of home do you live*
If you rent or live with a family member, please enter your landlord/family member's name and phone number
Is your yard fenced*
Yard Partially Fenced
Yard Completely Fenced
If no yard, are you able/willing to walk a dog at least 3 times per day?
What type of fence
What is the height of the fence*
How many people reside in your household? Please provide names and ages for all household members*
List your pet(s) names and species (dog/cat) - please go back at least 5 years:
How old are your current pet(s)?
Do your pet(s) live indoors or outdoors?
Inside and Outside
How long have your pet(s) been in your care?
Are your current pet(s) spayed or neutered?
All your current pets are: On monthly heartworm preventative (Dogs)
All your current pet(s) are: on monthly flea/tick preventative
All your current pet(s) are up to date on vaccinations
All your current pet(s) are microchipped and/or wear ID tags at all times
Who in the household will care for the pet*
Why are you interested in adopting a pet at this time?*
How much time will the adopted animal spend alone during the day*
Will the adopted animal be kept inside or outside*
Inside and Outside
Where will the adopted animal be kept when you are not home during the day*
Where will the adopted animal be kept when you are home*
Where will the animal be kept when you're on vacation
Where will the adopted animal sleep*
For Dogs: You agree to provide monthly heartworm preventative?*
You agree to provide monthly flea/tick preventative
You agree to keep pet up to date on vaccinations
You agree the pet will be microchipped and/or wear ID tags at all times
For cats only: Are you planning to declaw
Describe how you will train the pet*
Veterinarian's Name(s) and Phone Number(s) (include current pet(s) and pet(s) listed above)*
Does ASVT have your permission to contact your veterinarian?*
Are you financially able and willing to provide medical care should the pet become ill?*
Are you financially able and willing to provide annual checkups and vaccinations?
Are you financially able and willing to provide monthly flea/tick and heartworm preventatives?*
Are you willing to take responsibility for this pet for its entire life?*
What will happen to this pet should you move or can no longer care for it?
Have you ever given up a pet? If yes, please explain*
Have you ever had a pet that was Lost, Hit by a Car, Put to Sleep or Given Away? If yes, what were the circumstances?
How did you hear about us*
By submitting this form, I certify that the information entered on this form is true and correct to the best of my knowledge. I understand that any misrepresentation of fact may result in a refusal of all adoption privileges. I authorize Animal Shelter Volunteers of Texas (ASVT) to contact all landlords and all veterinarians listed on the application. If my request for adoption is approved and ASVT discovers the above information is not true or correct, I understand that ASVT reserves the right to require the return of the adopted pet.
Please enter your name and the date you completed this form.*