APPLICATION FOR ADOPTION
Required fields are marked with
*
PERSONAL INFORMATION
Your name & Spouse:
*
E-mail:
*
Street Address:
*
City/State/Zip:
*
Home Phone:
*
Work Phone:
Cell Phone:
Best time to call:
*
PERSONAL REFERENCES
Personal Reference:
*
Address:
*
City/State/Zip:
*
Phone number:
*
Veterinarian Reference:
Phone number:
PETS INFORMATION
Is there a pet on our website
that you are interested in?:
Pet type you prefer:
*
Describe the qualities most
important to you in a pet:
*
GENERAL LIVING SITUATION
Do you live in:
*
N/A
House
Apartment
Other
If other, please explain:
Do you ...
*
N/A
Rent
Own
If Rent, Landlords name and phone:
How many adults
in your household?
*
How many children
in your household?
*
Children's ages:
YOUR PET HISTORY
Do you now or did you ever own a pet?
*
N/A
Yes
No
Please list all pets you have owned in the last 5 years.
Name
Breed
Age
Sex
*S/N
Where obtained?
Where is it now?
N/A
Male
Female
N/A
Yes
No
N/A
Male
Female
N/A
Yes
No
N/A
Male
Female
N/A
Yes
No
N/A
Male
Female
N/A
Yes
No
N/A
Male
Female
N/A
Yes
No
*S/N=Spayed/Neutered?
Do you have a fenced in yard?
*
N/A
Yes
No
If yes, please specify fence type and height
Is anyone in your home allergic to pets?
*
N/A
Yes
No
If yes, please explain:
Which family member will be responsible
for your new pet?
*
Where will pet be kept when you are not home?
*
N/A
In House
In Garage
In Yard
Other
If other, please explain:
How many hours per day will
your pet be
alone
outdoors?
*
N/A
Never
1-2
3-4
5-6
7+
Where will your pet sleep?
*
What is your work schedule?
*
What is your spouse's work schedule?
*
Do either of you come home at lunch?
*
N/A
Yes
No
ADDITIONAL INFORMATION
Have you ever surrendered a pet to
Anyone
?
*
N/A
Yes
No
If yes, please explain:
What brand of flea/tick prevention is/was your pet(s) on?
*
What brand of heartworm prevention is/was your pet(s) on?
*
If you move in the future, what will you do with your pet(s)?
*
If you go on vacation, what will you do with your pet(s)?
*
What are your feelings about obedience training?
*
What are your feelings about crate training?
*
Additional Comments
How did you hear about Pet Tender Angels?
*
N/A
Friends or Family
Search Engine Result
On Petfinder site
Link on another Pet site
Link on another Website
Just Surfing
Other
ELECTRONIC SIGNATURE
Your electronic signature below serves as acknowledgement that this is a sincere inquiry, and that all information provided is true,
correct and complete. On the Internet an Electronic Signature carries the same legal weight as if you were signing your name to a printed document.
To complete this form, please provide your electronic signature below by typing your name in the box, then submit the form.