Pet Adoption Form

Your Name*
First Last
Date
MM slash DD slash YYYY
Address*
Street Address City State ZIP Code
Home Phone
Work or Cell Phone
Email*
Employer
Where did you see or hear about this pet?*
How did you hear about Helping Strays?*
Are you interested in adopting a cat or a dog?*
- Cat
- Dog
Will this be your first pet?*
- Yes
- No
Do you have a weight, size, or breed restriction? If so, please explain.*
I would like a dog who:*
- Is a couch potato
- Is high energy
- Is very gentle
- Likes to roughhouse
- Loves strangers
- Prefers family
- Needs encouraging with strangers
- Is a cuddler
- Enjoys petting
- More independent
- Is quiet
- Talk occasionally
- Is male
- Is female
- Either sex
I would like a cat who
- Is a cuddler
- Enjoys petting
- Is quiet
- Loves strangers
- Is male
- Is female
Your Pets
Name Breed Type Spayed/Neutered Indoor or Outdoor? Age
Have they been tested for feline leukimia/FIV?
- Yes
- No
- Don't Know
Are they current on vaccinations?
- Yes
- No
- Don't Know
Have they been tested for Heartworms?
- Yes
- No
- Don't Know
Are they currently on Heartworm prevention?
- Yes
- No
- Don't Know
Please list pets you have had in the last 5 years who are no longer with you. Briefly describe what happened to them. (ie passed away/turned into shelter/rehomed/euthanized)
Have you ever had to surrender or return a pet before?*
- Yes
- No
If yes, explain
Who is your Veterinarian?
Phone
The veterinarian will have my pet records under the owner name of -
Are you aware of the cost of annual vaccinations and heartworm preventative and willing to provide this necessary care?
- Yes
- No
If you have pets, will they (or it) adjust to a new pet entering the household?
- Easily
- Some tension
- Don't know
- Requires assistance with introductions
I am adopting this pet for:*
- Human companionship
- Pet companion
- Playmate for children
I am adopting this pet for:*
- Human companionship
- Pet companion
- House pet
- Barn cat
- Mouser
- Office cat
Are you familiar with ways to encourage good house training behavior in your new dog?*
- Yes
- No
Have you ever participated in any type of formal pet training?*
- Yes
- No
If yes, what type of training and where?
How many adults, over age 21, are in your household?*
How many children?*
Children's ages?
Does any member of your household have an allergy to dogs?
- Yes
- No
- Don't know
How many hours per day will the pet be without human companionship?*
- 0-3
- 3-6
- 6-9
- 9-12
- more than 12
Where do you live?*
- House
- Apartment
- Condo
- Mobile Home
Do you own or rent your home?*
- Own
- Rent
Does your lease allow pets?
- Yes
- No
If you rent, what is your landlord's name to verify approval of a pet?
Number
Where will you keep the cat?*
- In the house
- Outdoors
- Free access indoors and outdoors
- In the barn
Are you planning to have this cat declawed?
- Yes
- No
Are you aware of the potential side effects of this operation?
- Yes
- No
How will you provide for your cat's physical and mental exercise while protecting your belongings?
Where will you keep the dog?*
- In the house
- Outdoors
- Both indoors and outdoors
Do you have a dog door?*
- No
- Yes
Do you have a completely fenced yard (not required for all dogs)?*
- Yes
- No
What kind of fence?
Fence Height:
Is there a gate that can be locked?
- Yes
- No
Are there times when your dog will be tied up?*
- Yes
- No
If yes, explain
Will the dog spend any time alone in the garage?*
- Yes
- No
If yes, explain
How much time would you have on a daily basis to exercise your dog?
Have you ever applied or adopted a pet from Helping Strays or Humane Society of Monroe County?*
- Yes
- No
If yes, explain
Are you willing to have a representative of Helping Strays come to see where the pet will live?*
- Yes
- No
If no, explain
Are you interested in a specific animal? Please give us their name
Why have you selected this particular pet?
Please list 3 references to your experience as a pet owner (only one family member)*
Name Phone Relation to You
Additional comments from applicant

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Name	Breed	Type	Spayed/Neutered	Indoor or Outdoor?	Age

Name	Phone	Relation to You