First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

County*

Email*

Cell Phone*

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

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

Veterinarian's Name(s) and Phone Number(s)*

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.

Does ASVT 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 Arla Barbie GS Big Sis Buddy Buffy Cole Goldie Jackson Jose Kiki Lady Licorice Lilith Lucille LuvBug Maggie Mae Mama Girl McFluffy McKenna Mr. Kitty Nimbus Peeta Pretty Girl Raven Rocco Romeo Ruby Tank Teddy Tripp Zeke Zeppy Zeus

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

If you rent, have you received the approval of your landlord to have an animal?*
Choose one: Yes No Not Applicable

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

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)*

Is your yard fenced*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

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

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*

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 pet(s) live 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 pets are: On monthly heartworm preventative (Dogs)*
Choose one: Yes No Not Applicable

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

All your current pet(s) are up to date on vaccinations*
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 cats have tested negative for FeLV/FIV*
Choose one: Yes No Not Applicable

Who in the household will care for the pet*

Why are you interested in adopting a pet at this time?*

During the day, how much time will the adopted animal spend alone?*

Will the adopted animal live inside the house or outside?*
Choose one: Inside Only Outside Only Inside and Outside

When you're away from home during the day, where will the adopted animal be kept? (outside, inside, crated, etc)*

When you're home, where will the adopted animal be kept (outside, inside, crated, etc)*

When you're on vacation, where will the animal be kept*

At night, where will the adopted animal sleep (outside, inside, crated, in bedroom, etc)*

For Dogs: You agree to provide monthly heartworm preventative?*
Choose one: Yes No

You agree to provide monthly flea/tick preventative?*
Choose one: Yes No

You agree to keep pet up to date on vaccinations*
Choose one: Yes No

You agree the pet will be microchipped and/or wear ID tags at all times*
Choose one: Yes No

For cats only: Are you planning to declaw*
Choose one: Yes No Not Applicable

Describe how you will train the pet*

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 preventatives?*
Choose one: Yes No

Are you willing to take responsibility for this pet for its entire life?*
Choose one: Yes No

Do you agree to return this pet to ASVT if, for any reason, you can no longer care for it?*

In the last 5 years, have you given up/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? 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.