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2. Please fill out the following information clearly and honestly.
4. Date*
   Date
6. Animal You Are Interested In*
8. Full Name*
9. Email*
11. Home Phone*
12. Cell Phone
14. Address*
16. City*
17. State*
18. Zip*
20. Employer*
22. Number of Adults in the Household Including Yourself*
23. Number of Children in the Household Including Yourself*
25. Is everyone in the household in agreement about adopting a new pet?*

    1. Yes
    2. No
26. Does anyone in your household have any known allergies to animals?*

    1. Yes
    2. No
28. How long have you been at your current address?*
29. Are you planning to move in the near future?*

    1. Yes
    2. No
31. Living Situation*

    1. Apartment
    2. House
    3. Mobile Home

    1. Own
    2. Rent
    3. Townhouse/Condo

    Please Check All That Apply
33. If you rent you need a lease stating that animals are allowed before being considered.
35. Landlord Name
36. Landlord Phone
38. Are animals permitted?

    1. Yes
    2. No
39. Do you have a lease stating animals are permitted?

    1. Yes
    2. No
43. For Dogs
45. Do you have a fenced yard?

    1. Yes
    2. No
46. Fence Type
47. Fence Height
49. How will you exercise the dog? Where? How often?
51. Have you had animals in the past? If yes please list breeds.
53. Please list animals you currently have including breed, sex, age, neutered/spayed, and if they are current on vaccinations.
55. Current or Past Vet Information
    If you have never owned a pet before and therefore did not have a vet, please disregard this section.
57. Vet Name
58. Vet Phone
60. Vet Address
62. Name the vet records are under?
63. Date of Last Vet Visit
    Date of Last Vet Visit
65. A dog/cat can live up to 20 years. Are you prepared and willing to give the medical treatment it needs for it's life span?*

    1. Yes
    2. No
67. Do you agree to have this animal spayed/neutered if it is not already?*

    1. Yes
    2. No
69. Are you prepared to bring your pet for its yearly exam and vaccinations?*

    1. Yes
    2. No
71. Where will this animal you adopt spend most of its time?

    1. Inside
    2. Outside
    3. Both

    1. Crated
    2. Loose in Home

    Check All That Apply
73. How long will the animal you adopt be left alone during the day?*
75. Are you willing and able to attend training classes if needed?*

    1. Yes
    2. No
77. Do you understand that bringing an animal home you must be patient and allow time for the animal to adjust to its new house/routine?*

    1. Yes
    2. No

    This may include house breaking accidents, chewing, barking, or hiding.
79. Have you ever relinquished or given up an animal? If yes please explain.
81. Please Read this Important Information
    We try to place the animals in a forever home. If we feel your application is unfit in any way, we have the right to decline you without further reasoning. The approval process typically takes 24/48 hours, in some cases this may be longer. Upon approval, there is a $40 non-refundable adoption fee.
    
    In order to be considered you must provide a photo identification with current address, a lease stating pets are permitted, and if vet information is given, an adequate vet check for your current or previous animals. If incorrect or misleading information is provided you will not be considered for the animal you are applying for or any other animal at this facility at any time.
    
    By clicking submit you certify that the information supplied on this application is true and confirm your acceptance of all therms and conditions stated in this application.
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83. 1. Receive an email copy of this form.
84. Email address

    This field is not part of the form submission.

85. Submit

* indicates a required field