First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Cell Phone*

Which animal are you interested in*
Choose an animal: *Pippa A Generic Cat/Kitten Application Apollo Betty Boo Bunny Butterball Chinzey Eggroll Emerson Garbo Jackson Joey Kiki Kiwi Milli Minerva Peaches Sheba aka Hera

List names of additional animals you are interested in, or breeds, age range, sex etc. if this is for a generic application

You must be 18 years or older to apply.

Occupation/(if applicable) Spouse's Occupation*

Are you a military veteran?*
Choose one: Yes No

Is this animal a gift? If yes, please explain:*

Do you own or rent your home*
Choose one: Rent Own

If you rent, provide your landlord's name and phone number

Reference One: Name, Phone, City/State, Relationship (no immediate family members), Years Acquainted*

Reference Two: Name, Phone, City/State, Relationship*

Please name people who reside in your household, or visit frequently. For example: Mary 31, Susan 16, John 12)*

If interested in a dog, is your yard fenced? If so, describe fence.

If you have pets, please list pet name, age, species and breed

If you have pet(s), please give us your veterinarian's name and phone number that has the shot and spay records.

If you have pets, are all up to date on their vaccines?
Choose one: Yes No

If you have pets, are all on flea/tick/heartworm prevention?
Choose one: Yes No

How would you handle a pet that destroyed furniture in your home by either clawing, chewing or urinating?*

What are your expectations for your pet? (house trained, litter trained, active, low energy, good temperament with children)*

Is there any behavior that is not acceptable? (examples: crate training, chewing, scratching, aggression)*

Would you be interested in classes on how to avoid bad behavior?*
Choose one: Yes No

I agree to all the information I have given is true. I also understand that submitting this application is not a guarantee that I am able to adopt.*