"ACCESS ADOPTION" APPLICATION

1. Type of pet preferred?

BIRD
CAT
DOG
HORSE
OTHER

2.    Although all pets available for adoption are sterilized, do you prefer a:

MALE
FEMALE
STERILIZED SO IT DOES NOT MATTER

3. Describe your ideal pet's size, weight, and height:

4.    And, if if you have coat/fur preferences, describe your ideal pet's coat/fur (color, length, texture):

5.    Describe your ideal pet's behavior and/or personality:

6.    Should your ideal pet have any other traits, or do you have any other preferences, that we might need to know in order to help you find the best potential pet?  If so, please list:

7.    Complete this sentence:  In reference to a pet, I absolutely love pets that:

8.    Complete this sentence:  In reference to a pet, I cannot tolerate pets that:

9.    I would like a pet:

10.    My lifestyle is best described as:

VERY ACTIVE (run, walk, swim or other other exercise daily)
ACTIVE (run, walk, swim or other exercise 2 or 3 times a week)
NORMAL (Consider yard or house work to be exercise, short walks)
INACTIVE (Rarely engage in physical activity)
EXTREMELY INACTIVE (couch potato, finding remote is exercise)

11.    Visitors come to my home an average of how many times per week?

0-5
6-10
10+

12.    I want this pet for (check all that apply):

Breeding purposes
Companionship
Gift
Protection

13.    The pet is mainly for?

Child(ren)
Friend
Myself
Relative
Spouse

14. Who will be the primary caretaker for the animal?

15. Most cities, counties and states have laws against pets roaming-at-large and requiring owners to license and vaccinate pets and provide their pets with adequate food, water and shelter?  Do you know what laws are applicable in your area?

YES
NO
NOT SURE... Let's talk about them.

16.    During the day, my pet will stay:

17.    At night, my pet will stay:

18.    Do you have a fenced yard?

YES
NO

19. If you have a fenced yard, describe it (appx. size of yard and description of fence including height, materials, age and condition):

20. Do you already own one or more pets?

YES
NO

21.    If so, please list (include type/breed, age, sex, disposition, weight/height) each pet you now own, whether it is current on its vaccinations and/or spayed/neutered, and whether it is kept inside or out:

22.    Name, address and phone number of your veterinarian:

23.    Have you owned animal(s) previously that you no longer have?

YES
NO

24.    List each pet you have previously owned, where it is now, and, if deceased, its age at time of death and the cause of death:

25.    Owning an animal requires a real commitment on your part.  The commitment should be for the life of the animal and include, but not be limited to, time expended in caring for the pet, expenses (hundreds of dollars yearly) for grooming, food, toys, yearly vaccinations and parasite control, training (if necessary) and the occasional extraordinary expenses (potentially thousands of dollars) related to any medical attention the pet may require.  Are you ready to make this commitment?

YES - I am willing
NO - I probably don't need to get a pet right now.

26.    Each year, millions of animals are killed because owners do not understand their pets' behaviors (basic and/or normal) and/or because owners undergo lifestyle changes that make continued ownership inconvenient.  Please tell us what reasons you consider to be valid reasons for getting rid of a pet?

27.    How much time do you plan to spend with your pet each day?

Less than 1 hour
1-2 hours
3-5 hours
5 or more hours

28.    Do you travel frequently?

YES
NO

29.    If you answered that you do travel frequently, will your pet be going with you in the future?

YES
NO
SOMETIMES

30.    If something happened to you that made keeping a pet impossible, what would you do and who would care for your pet?

31.    Are you willing to take your pet to obedience classes and/or an animal behaviorist, if necessary?

YES
NO
MAYBE

32.    Please provide the names and contact information for three people who have known you two or more years:

33.    What have you done to prepare yourself and your home for a pet? (Check all that apply.)

Researched
Purchased and read books
Purchased items (bed, toys, collar/leash, food)
Consulted with people who own similar pets
Consulted Vet about basic care requirements
Discussed with all family members in home

34.    If it ever becomes necessary to relinquish this pet, are you willing to agree to return it to the applicable animal rescue agency?

Yes
No

35.    Please enter today's date:

(mm/dd/yy)

36.    Please provide the following contact information:

First Name
Last Name
Work Phone
Home Phone
FAX
E-mail

37.    Please describe your home:

APARTMENT
CONDO
DUPLEX
HOUSE
MILITARY HOUSING
MOBILE HOME
OTHER

38.    Do you own or rent?

OWN
RENT

39.    If renting, does your lease permit pets?

YES - NO RESTRICTIONS
YES - WITH RESTRICTIONS
NO

40.    If you answered "YES - WITH RESTRICTIONS," please list applicable restrictions on size, type, or number of pets permitted:

41.    If you rent, please provide your landlord's name and contact information (including address and phone number):

42.    If you find a pet you want to adopt, are you be willing to let someone visit your home to interview you as a potential owner?

YES - ANYTIME
YES - BY APPOINTMENT ONLY
NO