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Preliminary Pet Adoption Application
APPLICANTS INFORMATION
Name
(required)
Date of Birth
Address
(required)
City
(required)
State
(required)
Zip
(required)
E-mail address
(valid email required)
Home Phone
Work Phone
Mobile Phone
Own or Rent?
Own
Rent
How long?
3. Do you live in a
Condo - Townhouse
Duplex
Mobile Home
House
Apt
Drivers License #
EMPLOYMENT INFORMATION
Current employer
Employer address
How long?
Phone
E-mail
(valid email required)
Fax
City
State
ZIP Code
Position
Full Time?
Yes
No
Approx. Annual income
PERSONAL REFERENCE
Name of an unrelated personal reference not residing with you
Phone
Address
City
State
ZIP Code
Relationship
VETERINARIAN REFERENCE
Name
Address
City
State
ZIP Code
Phone
CURRENT PET INFO
Number of Dogs in household
Names/Age
Number of Cats in household
Names/Age
Other Pets
Dog(s) kept
In
Out
Both
Cat(s) kept
In
Out
Both
Dog Crated
Yes
No
Pets current with vaccinations
Yes
No
Heartworm Negative
Yes
No
Not Sure
Feline Leukemia/FIV
Yes
No
Not Sure
Dogs spayed/neutered
Yes
No
Cats spayed/neutered
Yes
No
Cat De-clawed
Yes
No
LANDLORD INFO
Name
Address
Phone
Do you have a pet clause in lease?
Yes
No
Pet Deposit Paid?
Yes
No
Pet Restrictions
HOUSEHOLD INFO
Atmosphere
Grand Central
Zen Garden
In Between
# Children Under 5 years
# Over 5 Years
Time Away From Home
Home All Day
Away 7-10 hours
Other/please explain
Yard Fenced
Yes
No
Pet to be kept
Inside
Outside
Both
VERIFICATION
I authorize the verification of the information provided on this form
Date
Pet Name you are applying for
Pet Type
Dog
Cat
Other