Ready to adopt an animal?

Pet Name: Your Name: Your Age: Street Address: City: State: Zip Code: Email Address: Home Phone: Work Phone: Employer: Cell Phone:
List All Members of the Household:
Name:	Age:		Relationship to Applicant
List Other Companion Animals That Reside With Your Family: Animal: Breed: Name: Sex: Age: Spay/Neutered: Cat Dog Male Female Yes No Cat Dog Male Female Yes No Cat Dog Male Female Yes No Cat Dog Male Female Yes No Cat Dog Male Female Yes No Cat Dog Male Female Yes No
If your pet has passed away recently, please indicate the circumstances.	Have you had any pets in the last five years that are not listed above? If so, where are they now?
Do you own your Home or rent? Own Home Rent If this application is for a cat, will you declaw? Yes No Maybe	Landlord Name Landlord Telephone #
Where will your new pet be kept? Indoors Outdoors Both Where will your dog sleep at night? Is anyone in your household allergic to dogs or cats? Yes No If so, list who has pet allergies and the type:
Do you have a fenced in yard? Yes No
Type of Fence       Height
If not and you are adopting a dog, where will he/she be exercised?
Are you making a lifetime commitment to this pet? Yes No
Have you or your spouse ever released a pet to a shelter? Explain?	Under what circumstances would you consider giving up your pet?
Are you willing to seek out professional advice for behavioral problems with your new pet, should they arise? Yes No			What Brand of Food do you feed your Current/Past Pet?
How much do you think it will cost to feed this pet per week? $ How much do you think it will cost for medical care per year? $ Are you going to spay/neuter this pet? Yes No
How many hours will your pet be left alone each day? Is anyone going to be home during the day? Yes No If Yes, Who?
Veterinarian: Veterinarian's phone:   Please give a personal reference if no veterinary reference: Personal reference's phone:
You can put any special comments here:
By submitting this application, you are giving your consent for Animal Alliance to contact your veterinarian and above-listed personal references to inquire on the history of previously owned animals and animals currently in your care. You are also giving your veterinarian permission to release any medical information to Animal Alliance.