Adoption Application FormRequired fields are indicated with an asterisk *"*" indicates required fieldsToday's DateMonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920This application is for a:* Cat DogHave you already spoken to an Animal Aid adoption counselor?*How did you hear about Animal Aid?*Have you ever adopted or applied to adopt an animal from Animal Aid?*Adopter InformationFirst and Last Name(s):*Pronouns:*Age:*Address:* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Primary phone:*May we text this number with questions about your application? Yes NoSecondary phone:Other phone:Primary email:* Secondary email: Other:Your occupation and employer:*Tell us about your decision to adoptWhy are you considering adopting?*Describe the type of animal companion that you think would best fit your life (e.g., personality, energy level, size, quantity):*Are you interested in a specific animal?*Are you adopting this animal for yourself?*Do you have a size or color preference?*Do you have an age preference?*Preferred sex:*Are you looking for an indoor, indoor/outdoor, or outdoor cat?* Outdoor Indoor/Outdoor IndoorHave you ever had a cat declawed?* Yes NoIf you adopt a cat, do you intend to declaw it?* Yes NoIf you answered "yes" to either of the above questions, please explain why:How many hours a day will your pet be left alone? How many days will they be left due to travel?*Tell us about your householdPlease list the names and relationships of the adults in the home:*Are there children living in your home or who visit regularly?*Does anyone in the household have animal-related allergies?*Is everyone in your household in favor of adopting an animal?*Tell us about where you liveIs your residence a:* House Apartment Condo Mobile Home OtherDo you:* Rent Own Live with Family OtherOn what estimated date did you move into your residence? (Month and Year)*Do you plan to move soon? If you move, will your animal go with you?*RENTERS ONLYName of landlord or apartment complex manager: First Last Phone number for landlord or manager:What is the pet policy concerning the allowed type and number of animals?What is the pet deposit and/or pet rent amount?Have you paid the pet deposit?Tell us about the animals that are currently a part of your householdHow many animals are currently a part of your household?*Animal #1Species:Name:Please tell us a little bit about them and their personality/temperament (e.g., size, energy level, play style, etc.):How did you acquire this animal?Age then:Age now:Sex:Are they neutered or spayed?Are their vaccinations current?(Cats) Have they tested negative for FeLV/FIV?(Cats) Are they declawed?Do they have a microchip or tattoo?Are they licensed?Where does this animal stay?Animal #2Species:Name:Please tell us a little bit about them and their personality/temperament (e.g., size, energy level, play style, etc.):How did you acquire this animal?Age then:Age now:Sex:Are they neutered or spayed?Are their vaccinations current?(Cats) Have they tested negative for FeLV/FIV?(Cats) Are they declawed?Do they have a microchip or tattoo?Are they licensed?Where does this animal stay?Animal #3Species:Name:Please tell us a little bit about them and their personality/temperament (e.g., size, energy level, play style, etc.):How did you acquire this animal?Age then:Age now:Sex:Are they neutered or spayed?Are their vaccinations current?(Cats) Have they tested negative for FeLV/FIV?(Cats) Are they declawed?Do they have a microchip or tattoo?Are their vaccinations current?Are they licensed?Where does this animal stay?Animal #4Species:Name:Please tell us a little bit about them and their personality/temperament (e.g., size, energy level, play style, etc.):How did you acquire this animal?Age then:Age now:Sex:Are they neutered or spayed?Are their vaccinations current?(Cats) Have they tested negative for FeLV/FIV?(Cats) Are they declawed?Do they have a microchip or tattoo?Are they licensed?Where does this animal stay?Animal #5Species:Name:Please tell us a little bit about them and their personality/temperament (e.g., size, energy level, play style, etc.):How did you acquire this animal?Age then:Age now:Sex:Are they neutered or spayed?Are their vaccinations current?(Cats) Have they tested negative for FeLV/FIV?(Cats) Are they declawed?Do they have a microchip or tattoo?Are they licensed?Where does this animal stay?Animal #6Species:Name:Please tell us a little bit about them and their personality/temperament (e.g., size, energy level, play style, etc.):How did you acquire this animal?Age then:Age now:Sex:Are they neutered or spayed?Are their vaccinations current?(Cats) Have they tested negative for FeLV/FIV?(Cats) Are they declawed?Do they have a microchip or tattoo?Are they licensed?Where does this animal stay?Animal #7Species:Name:Please tell us a little bit about them and their personality/temperament (e.g., size, energy level, play style, etc.):How did you acquire this animal?Age then:Age now:Sex:Are they neutered or spayed?Are their vaccinations current?(Cats) Have they tested negative for FeLV/FIV?(Cats) Are they declawed?Do they have a microchip or tattoo?Are they licensed?Where does this animal stay?Animal #8Species:Name:Please tell us a little bit about them and their personality/temperament (e.g., size, energy level, play style, etc.):How did you acquire this animal?Age then:Age now:Sex:Are they neutered or spayed?Are their vaccinations current?(Cats) Have they tested negative for FeLV/FIV?(Cats) Are they declawed?Do they have a microchip or tattoo?Are they licensed?Where does this animal stay?What other animals have you had in the past five years?How many other animals have you had in the last five years?*Animal #1Species:Name:How long did you have them?What happened to them and when?How old were they at the time?Animal #2Species:Name:How long did you have them?What happened to them and when?How old were they at the time?Animal #3Species:Name:How long did you have them?What happened to them and when?How old were they at the time?Animal #4Species:Name:How long did you have them?What happened to them and when?How old were they at the time?Animal #5Species:Name:How long did you have them?What happened to them and when?How old were they at the time?What brand/type of food have you fed your current or past animals?*What brand/type of food do you plan to feed the animal you are adopting?*(Cats) How many litter boxes do you plan to have and where will they be placed?If applicable, describe how your current animals interact with each other:Planning aheadDescribe your home, yard, and neighborhood:*Do you have a pet door? If yes, where does it go?*Where will your animal stay during the day?*Where will your animal stay at night?*How would you introduce a new animal to your family and current animals?How will you confine your animal to your property?*Describe how your animal will be cared for if you are away for more than a day:*How would you handle potentially problematic behaviors (e.g., aggression, reactivity, destructive behaviors, inappropriate marking, etc.)?*Name some reasons that might cause you to give up your animal:*If you experience changes in your life, finances, or ability that cause you to become unable to care for your animal, what plans have you made?*What is your anticipated annual budget and resources to care for your animal? Consider such elements as food, vet care, and training. Please include a numerical estimate along with any additional resources you have (e.g., pet insurance, trainer connections, donated or discounted food/supplies, etc.).*Are you willing to go to the expense and time of taking your animal to a veterinarian for full preventative and medical care at least once a year?* Yes NoWould you object to a follow-up visit from an Animal Aid representative to see how the animal is doing in their new home?* Yes NoPlease list all the veterinarians (local and out of area) who have cared for your animals in the past 5 yearsHow many veterinarians have cared for your animals in the past 5 years? (Please enter a number)*Veterinarian #1Clinic name:*Clinic city and state: City State / Province / Region Clinic phone number:Veterinarian #2Clinic name:Clinic city and state: City State / Province / Region Clinic phone number:Veterinarian #3Clinic name:Clinic city and state: City State / Province / Region Clinic phone number:Veterinarian #4Clinic name:Clinic city and state: City State / Province / Region Clinic phone number:Are any of your animals currently under treatment or taking medications?Has one of your animals or any animal in your care died of distemper, leukemia, parvo, FIP, or unknown causes in the last 6 months?*References - Professional or Personal (Non-family, please)How many references do you have? 3 references are required for those without a veterinary reference. Only 2 references are needed if you have a veterinarian listed above.*Please enter a number from 1 to 4.Reference #1 (non-family, please)Name:* First Last Years known:*Relationship:*Phone:*Email:Reference #2 (non-family, please)Name:* First Last Years known:*Relationship:*Phone:*Email:Reference #3 (non-family, please)Name: First Last Years known:Relationship:Phone:Email:Reference #4 (non-family, please)Name: First Last Years Known:Relationship:Email:Questions for us?Do you have any questions and/or feedback about the information we have requested on this form?Are there any additional topics you'd like to discuss during a follow-up conversation with one of our adoption counselors?SignatureI attest that the above information is accurate and give Animal Aid, Inc. permission to verify any of the above. I understand that giving false information is grounds for denying my application.* YesPlease type your name*
