First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Home Phone*
Work Phone x
Cell Phone
Mailing Address if Different from Above
Date
Name of pet you are interested in:
Name of EAPL Representative working with you, if applicable:
How did you hear about EAPL?
How long have you been at your current address:
House Type: (check one)
Own Or Rent:
Landlord Name:
Landlord Number:
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List all pets owned (past & current in last 5 years)
List NAME, SPECIES, BREED, AGE, SPAYED/NEUTERED STATUS, AND PETS CURRENT LOCATION
PET 1
PET 2
PET 3
PET 4
PET 5
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How do you feel about spaying/neutering your new pet?
Why do you want this animal?
If other, please describe:
How many adults are in your family or house?
Names of other adults in the home:
Applicant age:
Applicant occupation:
How many children are in the home?
Ages of children:
Has everyone in the family agreed on adding a new pet to the family?
Who will be responsible for feeding, housetraining and obedience?
Is anyone in the family/house allergic to animals?
Is anyone home during the day?
If so, who?
How many hours will the pet be home alone on average during the day?
How do you plan to integrate this pet into your everyday home life?
Where will it be when you are away from home for short periods of times or during your work schedule?
Where will it be when you are home?
Where will it sleep?
Who will care for it if you are away for a few days?
How will you deal with the following behaviors if the pet exhibits them once he/she is in your home:
Fence Jumping
Growling / Showing Teeth
Biting
Chewing
Housebreaking Accidents
Being Too Active
Incompatibility with other pets
Illness in Pet
Veterinarian Information
Veterinarian Name:
Veterinarian Hospital:
Veterinarian City:
Veterinarian Phone:
Do you have a fenced yard?
If so, what type?
What is the fence height at its lowest point?
If you do not have a fence, how will the pet go about getting exercise and doing "business"?
It is EAPL policy to do a home visit. Would you object to this?
How do you plan to train the pet?
What hobbies/activities do you do where you can/will include the pet?
Do you drive a pickup truck?
Will you let the pet ride in the back?
Do you know the local ordinances in the county in which you live?
Admin Use Only
EAPL Representative Comments: