First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Cell Phone*

What pet are you interested in adopting?*

How did you hear about us?*

Please include a personal reference for us to contact. Please include their phone number and relationship to you.*

Do you currently have any pets?*
Choose one: Yes No

If Yes, What type of pet(s) do you have? (Please list all pets.)

If Yes, What age are all of your pets? (Please list all pets.)

If Yes, What breed are your pets? (Please list all pets.)

If yes, are any of your pets spayed or neutered? (Please list all pets if applicable.)

If yes, when did you last bring your pets to the vet? (Please list all pets.)

If yes, who is your veterinarian? Please include their phone number. (Please list all pets.)

If yes, whose name are your vet records under? (Please list all pets.)

Are all pets vaccinated?
Choose one: Yes No

If yes, where do you keep your pets? (Please list all pets.)

Have you had any pets in the past?*
Choose one: Yes No

If yes, what type of pet(s) did you have? (Please list all pets.)

If yes, how long did you have your last pet and what was the pets name? (Please list all pets.)

If yes, what happened to your last pet? (Please list all pets.)

Who was your veterinarian? Please include their phone number. (Please list all pets.)

Whose name are your past vet records under? (Please list all pets.)

Do all adults know that you plan to adopt?*
Choose one: Yes No

If there are children in your household please list by age.

Are there any known allergies or medical conditions in your household?*
Choose one: Yes No

Where will your new pet be kept during the day?*

Is there anyone home all day?*
Choose one: Yes No

Where will your new pet be kept while alone and when you go on vacation?*

A cat can live 15-20 years. Are you financially able to give a cat routine and emergency medical care? *
Choose one: Yes No

Do you plan on having your cat declawed?*
Choose one: Yes No

Would you object to a visit or call from a volunteer to see how you and your new pet are doing?*
Choose one: Yes No

Are you familiar with the pet licensing laws in your community?*
Choose one: Yes No

How many people live in your household?*

Are pets allowed where you live?*
Choose one: Yes No

You currently live in a ____.*
Choose one: House Apartment Other

Do you currently rent or own your house/apartment?*
Choose one: Rent Own

How long have you lived at your current address?*

What is your current occupation?*

Please tell us anything else about yourself that you may want the adoption counselor to know and to take into consideration about your ability to adopt one of our pets?

Please make sure you understand the following terms.

- Best Friend Dog and Animal Adoption serves the right to refuse any adoption application.
- The information contained within this application is accurate and not misleading in any way.
- Best Friend Dog and Animal Adoption reserves the right to contact any individuals on this form.

By signing below, you certify that you fully understand the terms written above.

Electronic Signature*