This Is a Test Application

Name: Date:

Address:

City: State: Zip:

Phone: Cell: Email:

Applying for: Are you looking for an inside or outside pet?

Housing Information:

Do you: Own Rent Live with Parent/Relative Mobile Home Condo

Parent/Relative/Landlord Name:

Parent/Relative/Landlord Phone:

Are your parents/relative (if you live with them) aware that you are requesting to adopt? Yes No

Is your landlord (if you rent) aware that you are requesting to adopt? Yes No

Are you planning on moving within the next 3 months? Yes No

Is this animal a gift? Yes No If yes, for whom?

Do you use for your current pet(s)? (check all that apply)

Crate Doghouse Runner/Tie Out Chain Full Fenced Yard Outside Pen

Leash Basement Invisible Fence Garage Partial Fenced Yard

Family Information:

Relationship Status Single Married Divorced In a Relationship

Do you have any children? Yes No If so, what are their ages?

Is anyone in your home allergic to dogs or cats? Yes No

Pet Information:

Do you have any other pets? If so, mark how many on the line. (check all that apply)

Dog Small Animal Rabbit Reptile

Cat Ferret Bird Fish

Breed: Age: Sex: Spayed/Neutered: Approx. Date of Shots:

Who is your Veterinarian? Phone:

May we contact your Veterinarian? Yes No

Are your pets (current or previous) on heartworm preventative? Yes No No Pets

Name of heartworm preventative:

Are your pets (current or previous) up to date on their vaccines? Yes No No Pets

Where are your pets (current or previous) housed?

When home alone, the new pet will be: (check all that apply)

In a kennel that is … Outdoor Indoor Both How many hours?

Tied up outside with a … Cable Run Chain How many hours?

Kept loose … Outdoor Indoor How many hours?

Are you prepared to spend several weeks or perhaps months, waiting for your new companion animal to adjust to their new environment and for you to adjust to this animal? Yes No

Do you understand that adopting a pet is a commitment for the animal’s entire lifetime? Yes No

Are you willing to accept that responsibility? Yes No

If, for any reason or at any time, I am unable to care for my adopted pet, I agree to return my adopted pet to Four Paws Sake, Inc.; I further agree never to abandon my adopted pet or deposit my adopted pet at an animal shelter or research facility; however, before returning my adopted pet to Four Paws Sake, Inc., I agree to exhaust all options available to me including, but not limited to, obedience training, a behaviorist, crate training or veterinary advice to solve any physical or behavioral problem that may occur with my adopted pet or between me and my adopted pet.

I am at least 18 years of age and can provide current valid picture identification. I agree that by accepting my pet for adoption, I am accepting guardianship of the animal. I understand this means that Four Paws Sake, Inc. is not responsible for any damage or illness to person, animal or property that may be caused by my adopted pet after the date of the adoption and I accept full legal and financial responsibility for my adopted pet from the date of the adoption forward.

I hereby attest that the above information, to the best of my knowledge, is accurate and true.

Potential Adopter’s Signature: Date:

FOR OFFICE USE ONLY

Veterinarian Notes:

Current on Shots: Heartworm Test: Heartworm Preventative:

Last Visit: Spay/Neuter:

Staff Notes: