Adoption Application
/Applicant Information
Name:
Current address: City: State: Zip:
Phone: Email:
Which animal are you interested in?
APPLICANTS NEIGHBORHOOD Environment
Type of neighborhood: Urban Suburban Rural
Type of home (circle): Single-Family Duplex Apartment Mobile Home
Do you (circle): Own Rent / How long?
If applicable, name of apartment complex or home owners association:
If renting, does your landlord approve of pets? Y / N
If renting are there restrictions based on breed? Y / N
APPLICANTS PETS
Do you have any other pets? Y / N Type (circle): Dogs Cats Other
How many? Dogs ____ Cats ____ Other ____
If Cats, have they been tested for feLV? Y / N Results (circle)? Positive / Negative
Are all of your pets altered? Y / N If not, which and why not?
Are all of your pets current on their shots? Y / N If not, why not?
Who is your vet?
FAMILY
Do you have children? Y / N How many?
Ages: / Elderly or disabled family members: Y / N
Home Environment
Is there a front yard? Y / N Back? Y / N Fenced Yard? Y / N Fence Type: Height:
Is their adequate shade from the heat and elements outside? Y / N Type:
Will the animal be primarily indoor or outdoor? Where will the animal sleep?
Where will the dog stay when no one is at home? / Hours? / How Often?
Are you willing to take the animal to vet appoints? Y / N
Are you aware there is a required home inspection check? Y / N What day/Time is best?
Background
Have you or anyone in your immediate family ever been convicted of a charge of cruelty to animals? Y / N
If so, please describe:
Have you ever given up an animal? Y / N If so please explain how and why:
Interviewer Name: Date:
Signature:
10645 N Oracle Rd., Suite 121-165, Oro Valley, AZ 85737