Adoption Application OLDAdoption Application for:* 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?HOW CAN WE REACH YOUName(s)*Your Pronouns:*What is your age?*You must be 21 or over to adopt.Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Primary Phone*Secondary PhoneOther PhonePrimary Email* Secondary Email OtherYour Employer and occupation*TELL US ABOUT YOUR DECISION TO ADOPTWhy are you considering adopting?*Describe the type of pet (personality, energy-level, size, quantity) that you think would best fit your life:Are you interested in a specific pet?*Are you adopting this pet for yourself?*Do you have a breed / color preference?Age preference?Preferred SexHave you ever had one of your cats declawed?* Yes NoIf you adopt a cat, do you intend to declaw it?* Yes NoIf you answered Yes to either of the above questions, why?How many hours a day or how many days due to travel will your new pet be left alone?*TELL US ABOUT YOUR HOUSEHOLDAre there children living in your home, or who visit regularly?*Please list the names and relationships of adults in home.*Does anyone in the household have animal-related allergies?*Is everyone in your household in favor of adopting a pet?*TELL US ABOUT WHERE YOU LIVEIs your residence a:* House Apartment Condo Mobile Home OtherDo you:* Rent Own Live with Family OtherOn what date did you move into your current address?*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Do you plan to move soon? If you move will your pet go with you?*RENTERS ONLYApt Complex / Mgr or Landlord name: First Last Mgr. Contact PhoneWhat is the Pet Policy concerning the allowed number and type of pets?Pet deposit and/or pet rent amount:Pet Deposit Paid?TELL US ABOUT ALL PETS THAT ARE CURRENTLY PART OF YOUR HOUSEHOLDHow many pets are currently part of your household?*Pet #1BreedNameHow did you acquire this pet?Age ThenAge NowSexNeutered / Spayed?Vaccinations Current?(Cats)Tested neg for FeLV / FIV?(Cats) Declawed?Has a Microchip or TattooLicensed?Where does this pet stay?Pet #2BreedNameHow did you acquire this pet?Age ThenAge NowSexNeutered / Spayed?Vaccinations Current?(Cats) Tested neg for FeLV / FIV?(Cats) Declawed?Microchip / TattooLicensed?Where does this pet stay?Pet #3BreedNameHow did you acquire this pet?Age ThenAge NowSexNeutered / Spayed?Vaccinations Current?(Cats) Tested neg for FeLV / FIV?Declawed?Microchip / TattooVaccinations Current?Licensed?Where does this pet stay?Pet #4BreedNameHow did you acquire this pet?Age ThenAge NowSexNeutered / Spayed?Vaccinations Current?(Cats) Tested neg for FeLV / FIV?(Cats) Declawed?Microchip / TattooLicensed?Where does this pet stay?Pet #5BreedNameHow did you acquire this pet?Age ThenAge NowSexNeutered / Spayed?Vaccinations Current?Tested neg for FeLV / FIVDeclawed?Microchip / TattooLicensed?Where does this pet stay?Pet #6BreedNameHow did you acquire this pet?Age ThenAge NowSexNeutered / Spayed?Vaccinations Current?Tested neg for FeLV / FIVDeclawed?Microchip / TattooLicensed?Where does this pet stay?Pet #7BreedNameHow did you acquire this pet?Age ThenAge NowSexNeutered / Spayed?Vaccinations Current?Tested neg for FeLV / FIVDeclawed?Microchip / TattooLicensed?Where does this pet stay?Pet #8BreedNameHow did you acquire this pet?Age ThenAge NowSexNeutered / Spayed?Vaccinations Current?Tested neg for FeLV / FIVDeclawed?Microchip / TattooLicensed?Where does this pet stay?WHAT OTHER PETS HAVE YOU HAD IN THE LAST FIVE YEARS?How many other pets have you had in the last five years?*Pet #1BreedNameHow long did you have it?What happened to it? Year?How old was it at the time?Pet #2BreedNameHow long did you have it?What happened to it? Year?How old was it at the time?Pet #3BreedNameHow long did you have it?What happened to it? Year?How old was it at the time?Pet #4BreedNameHow long did you have it?What happened to it? Year?How old was it at the time?Pet #5BreedNameHow long did you have it?What happened to it? Year?How old was it 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?*How many litter boxes do you or did you have and where are / were they placed?How many litter boxes and where do you plan to have in your home for this cat?Describe how your current pets 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 new pet stay during the day?*Where will your pet stay at night?*How would you introduce a new animal to your family and current pets?How will you confine your pet to your property?*Describe how your pet will be cared for if you are away for more than a day:*How would you handle problem behavior (aggression, destructive behavior, marking) on the part of a pet?*Name some reasons that might cause you to give up your pet:*If you become unable to care for your pet due to life changes, finances or disability, what plans have you made?*How much money per year do you anticipate spending on this pet? (Please include a numerical estimate)*Are you willing to go to the expense and time of taking your new pet to a veterinarian for full preventative and medical care at least once a year?* Yes NoWould you object to a follow-up visit from our representative to see how the pet is doing in its new home?* Yes NoPlease list all the veterinarians (local and out of area) who have cared for your animals in the past 5 years.How 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 PhoneVeterinarian #2Clinic NameClinic City and State City State / Province / Region Contact PhoneVeterinarian #3Clinic NameClinic City and State City State / Province / Region Contact PhoneVeterinarian #4Clinic NameClinic City and State City State / Province / Region Contact PhoneAre any of your pets currently under treatment / taking medications?Has one of your pets 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)How many references do you have? 3 references are required. Only 2 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*EmailReference #2 (non-family, please)Name* First Last Years Known*Relationship*Phone*EmailReference #3 (non-family, please)Name First Last Years KnownRelationshipPhoneEmailReference #4 (non-family, please)Name First Last Years KnownRelationshipEmailUntitledType Your Name*I 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.* YesCommentsThis field is for validation purposes and should be left unchanged.Linda's TestChecking how a link might be addedPlease review Animal Aid's mission, vision, and values statements before submitting your answer.breed of interest* dog catthis time with radio buttons* dog catConsent* I have read and agree to the document in the link above
