First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County*

Email*

Cell Phone*

TX Driver's License (or Texas ID) number:*

ASVT requires adopters to be 21 years of age or older. What is your birthdate/age?*

Does ASVT have your permission to contact your veterinarian? This is a requirement if you have had pets within the last 5 years.*
Choose one: Yes No

NOTE: Most veterinarian clinics require verbal permission from the client before information is released. Please call your veterinarian clinic now and give them permission to discuss your pets with ASVT. Failure to call will result in delays in processing your adoption application. Veterinarian's Name(s) and Phone Number(s)*

ASVT uses online maps and public data to confirm your home's location/ownership. If ASVT is not able to fully confirm your property, do we have your permission to do a home visit?*
Choose one: Yes No

Please select the animal in which you are interested.*
Choose an animal: Abby AJ Axel Beauty Big Sis Bingo Binx Biscuit Braveheart Breadcrumb Buffy Candy Char Cleo (Cat) Cleo (Tabby Cat) Cole Daisy Mae Delilah Dixie Doc Dominik Dora Dori Duke Fred (Cat) Fred (Dog) Gabbie Gibbs Hazelnut Jade JD Kiara Licorice Lucille Mighty Mouse Mr. Kitty Nefee Paris Piper Pretty Girl Rawhide Rocco Ruby Simba Spud Starla Thumper Tiger Tripp Ursa Vader Willow (Cat) Willow (Dog) Ying Yang Zeke

In what type of home do you live*
Choose one: Single Family Condominium Apartment Mobile Home

Do you own or rent your home or live with a family member*
Choose one: Own Rent Live with Family Member

ASVT requires verbal landlord approval. If you rent, have you received the approval of your landlord to have a pet and paid any deposit required?*
Choose one: Yes No Not Applicable

If you rent or live with a family member, please enter your landlord/family member's name and phone number (if you own your home, enter N/A)*

ASVT prefers dogs have a safe place to go outside. Is your yard fenced*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

What type of fence*
Choose one: Chain Link Invisible Privacy (Wood or Plastic) Wood and Wire Wrought Iron No Fence

What is the height of the fence*

If no yard, are you able/willing to leash walk a dog at least 3 times per day?*
Choose one: Yes No Not Applicable

ASVT will not place pets in homes not suited for their behavior or characteristics. How many people reside in your household? Please provide names and ages for all household members*

List your pet(s) name, species (dog/cat), age and if they are spayed/neutered - please go back at least 5 years. Please do not include pets owned by other family members (parents, grandparents, etc)*

Do your current pet(s) primarily live (eat, sleep, spend the majority of their time) indoors or outdoors? *
Choose one: Inside Only Outside Only Inside and Outside

How long have your pet(s) been in your care? (If not applicable, enter N/A)*

All your current pet(s) are up to date on vaccinations*
Choose one: Yes No Not Applicable

All your current pet(s) are on monthly heartworm preventive (Dogs)*
Choose one: Yes No Not Applicable

All your current pet(s) are on monthly flea/tick preventive*
Choose one: Yes No Not Applicable

All your current pet(s) are microchipped and/or wear ID tags at all times*
Choose one: Yes No Not Applicable

All your current cat(s) have tested negative for FeLV/FIV*
Choose one: Yes No Not Applicable

Who in the household will care for the pet; for instance take to vet, feed, train?*

Why are you interested in adopting a pet now?*

Some pets suffer from anxiety if left alone. On average, during the day, how many hours are you and your household away from your home?*

Will the adopted pet primarily live (eat, sleep, spend the majority of their time) inside the house or outside?*
Choose one: Inside Only Outside Only Inside and Outside

Some pets express anxiety by howling or tearing things up. During the day, when your household is away from home, how will the adopted pet be kept? (ie outside in a safe area or tied up, inside in a safe area or have run of the house, crated, etc)*

Pets need to be part of a family. When your household is home during the day, where will the adopted pet be primarily kept (ie outside in a safe area or tied up, inside in a safe area or have run of the house, crated, etc)*

At night, where do you plan for the adopted pet to sleep (outside or inside, crated or not, in a bedroom or a public part of the home)*

Pets require care even if you and your household are away from home for longer than a day. When you're on vacation, where or how will the adopted pet be cared for*

Rabies vaccines are required by law. Other vaccines help keep your pet from getting life threatening diseases and need to be renewed yearly. You agree to keep pet up to date on vaccinations*
Choose one: Yes No

Dogs get heartworms from mosquito bites. For Dogs: You agree to provide monthly heartworm preventive*
Choose one: Yes No

Fleas not only bite animals but humans as well. You agree to provide monthly flea/tick preventive*
Choose one: Yes No

Most ASVT pets have a microchip inserted when they are spayed or neutered. The microchip's owner contact information must be updated and kept current. In addition to the microchip, all pets should wear ID tags at all times as well.*
Choose one: Yes No

Declawing a cat means the front knuckles of their feet are removed. For cats only: Are you planning to declaw your pet*
Choose one: Yes No Not Applicable

All pets need training, which requires the owner to be patient and consistent in their commands. Describe how you plan to train the pet not to potty in the house, obey simple commands, etc*

Having a pet is an ongoing financial obligation. Are you financially able and willing to provide medical care should the pet become ill?*
Choose one: Yes No

Are you financially able and willing to provide annual checkups and vaccinations?*
Choose one: Yes No

Are you financially able and willing to provide monthly flea/tick and heartworm preventives?*
Choose one: Yes No

Pets can live 15 or more years. Are you willing to take responsibility for this pet for its entire life?*
Choose one: Yes No

ASVT strongly believe advance planning for your pets is very important. Who will become responsible for this pet if you are no longer able to care for it (ie you move, develop allergies, divorce, death)? The person's name and phone number would be appreciated.*

In the last 5 years, have you or your household dumped, given up or surrendered a pet? If yes, please explain*

In the last 5 years, have you owned a pet that was Lost, Hit by a Car, Put to Sleep or Given Away or Surrendered? If yes, what were the circumstances*

How did you hear about ASVT*

Have you ever been convicted of a crime against a person or an animal?*
Choose one: Yes No

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. I WILL NOT SURRENDER THIS PET TO AN ANIMAL SHELTER OR ANIMAL CONTROL WITHOUT NOTIFYING ASVT FIRST. Please enter your name and the date you completed this form.*

Please press the submit button once and wait until the page displays a message that the form was submitted successfully or not.