| Name: |
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| Address: |
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| City: |
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| State: |
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| Phone Number: |
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| Best Time To Call: |
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| Email Address: |
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| What type of pet are you interested in? |
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| If other, please specify: |
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| Have you ever owned this type of pet before? |
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| What kinds of pets have you had (as the primary caregiver)? |
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| Do you want a young or an adult pet? |
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| Is this pet to reside with you and your family? |
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| If no, please specify: |
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| How many people are in the household? Please list the ages of any children: |
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| Does anyone in your house have allergies to pets? |
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| What is your motivation for getting a pet at this time? |
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| If you have surrendered a pet to an animal shelter or rescue, please tell us why. If not, respond with N/A. |
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| What type of pet are you interested in? |
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| If you could choose your ideal pet, what would that be? |
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| Please name any specific pet(s) on the web site that caught your eye. |
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| What other pets do you have? Please describe, listing the ages and whether or not they are spayed/neutered. |
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| If you travel, who looks after your pets when you are gone? |
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| Do we have your permission to talk with your vet if we need to? |
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| What veterinarian/clinic do you use? Please include veterinarian/clinic name along with city and/or phone number. |
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| Do you live in a house, apartment, townhouse, mobile home? Please describe... |
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| Do you own or rent your residence? |
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| If other, please specify: |
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| How long have you been at this address? |
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| Do you have a fenced-in yard (i.e. chain link, electric, kennel area, etc)? |
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| If yes, please specify: |
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| How will your pet be exercised? |
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| Will the pet be restricted to a certain area? If yes, please describe the area. |
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| How many hours during the average work day will the pet be left alone? |
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| Where will the pet be housed? |
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| Would you be willing to participate in obedience lessons? |
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| Are all your pets up-to-date on shots? |
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| Are your pets wearing collars with valid tags? |
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| Would you still be able to care for this pet if your home or family situation changed (divorce, relocation)? |
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| What best describes the primary pet caregiver? |
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| Do you fully understand the responsiblities to caring for the pet you have chosen? |
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| Are you prepared to commit to caring for this pet for the pet's lifetime? (Dogs and cats live up to 18 years, possibly longer depending on health and breed) |
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| Any Additional Comments: |
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| Did you read and understand the Pet Connection Terms of Adoption? (You will be required to sign a similar agreement at the time of adoption) |
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