Adoption Questionnaire

What is the name of the pet you're interested in adopting? *

Name *

First

Last

Your age *

Phone (cell) *

Phone (secondary number)

Email *

Your occupation *

Address *

Street Address

City *

State *

Zip *

Name of spouse/significant other/roommate/other family member *

Answer "NA" (Not applicable) if you have no spouse/significant other/roommate/other family member

How old is your spouse/significant other? *

Answer "NA" (Not applicable) if you have no spouse/significant other/roommate/other family member

Occupation of spouse/significant other *

Answer "NA" (Not applicable) if you have no spouse/significant other/roommate/other family member

Who will be primarily be responsible for the pet's care? *

Do all adults in your household know you plan to adopt? *

Are there children in the home or that visit frequently? *

What age(s) are the children living in this house? *

What age(s) are the children that visit frequently?

I am applying to adopt a: *

Dog
Cat
Barn Cat
Other

If you selected "Cat" above, do you plan on declawing this cat? *

If you chose "Other" above, please explain.

Do you own or rent? *

Own/buying
Rent
Living with parents/family
Other

How long have you lived at your current residence? *

Do you currently have a pet? Yes or No *

If yes, please answer a few questions about pets you currently have. If you don't currently have any pets, you can skip this section.

List animals currently living in your household. (Breed, sex, age for each animal)

If you currently have a dog, does it like/get along with: *

Other dogs
Cats
Does not like other animals
Unknown

If your dog does not like other animals, please explain:

If you currently have a cat, does it like/get along with: *

Other cats
Dogs
Does not like other animals
Unknown

If your cat does not like other animals, please explain:

Is your pet current on vaccines? *

Yes
No
Unknown

Is your dog(s) on year-round heartworm preventive? *

Are all cats and/or dogs in your house spayed or neutered? *

Yes ALL are spayed/neutered
No, none are spayed/neutered
Some are, some aren't

If any of your current cats and/or dogs are NOT spayed/neutered, please explain why not.

Do you own additional pets beyond the ones listed above? if so, please list any additional pets, including temperament.

Pet history as an adult (5yr span). Pets that I do not currently own. *

I have owned a pet in the past 5 years. Please provide more information in the next few questions.
I have NOT owned a pet in the last five years. Skip next few questions.

Dogs I've owned in the past 5 years, that I do not currently own.

Please list each dog you've owned in the last 5 years. What happened to this dog? if they have passed away, please list age and cause of death, if known.

Cats I've owned in the past 5 years, that I do not currently own.

Please list each cat you've owned in the last 5 years. What happened to this cat? if they have passed away, please list age and cause of death, if known.

Other pets I've owned in the past 5 years, that I do not currently own.

Please list each other pet you've owned in the last 5 years. What happened to this pet? if they have passed away, please list age and cause of death, if known.

If you chose other above, please explain:

What type of fence do you have? Stockade, Chain link, picket, etc. *

Where will the pet sleep at night? *

Where will the pet stay when you are not home? *

How many hours per day on average will the pet be left alone? *

Do you currently have a veterinarian? *

Yes (Please fill out information below)
No, I do not have a veterinarian.
I would like a referral for a veterinarian.

Name of current/last veterinarian.

Veterinarian phone number

Personal reference *

Please list your reference's name, email address and at least one phone number.

Have you made arrangements for your animals(s) in your current/future care in case of a catastrophic illness or in the event of your death? *

Yes.
No. Please give some thought and get something worked out, your fur baby depends on you.

Will you be able to live with fur on your furniture, stains on your rugs, a warm body on your bed and an animal who may be destructive at times? *

Yes
No, I need a trained pet
This is why I want an outside-only pet
I commit to patiently training my new pet

If the pet becomes destructive, what would you do? *

Adoptions may require a home inspection/virtual visit by an approved Pets and People Humane Society member. Will you agree to a home visit with one of our members? *

What are you looking for in a pet? Activity level preference? Temperament? *

Will the pet be able to go places with you? If so, what kind of places would you take it? *

Anything else you'd like us to know?

Please type your name. This serves as your signature, agreeing that you have provided accurate information to the best of your ability. *

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