Adoption Application
Animal you are interested in adopting
Bob (Cat - S2021043)
Cletus (Cat - S2021145)
Hubert (Rabbit - M2021002)
Rodney (Cat - U2021009)
Applicant's First Name
Applicant's Last Name
Street Address
City
State
Apartment Number (if applicable)
Zip Code
Phone Number
Email Address
Alternate Phone Number
Date of Birth
Drivers License Number
How did you find out about us?
Petfinder
Internet Search
Family/Friend
Staff/Volunteer
Facebook/Twitter
Other
Have you applied anywhere else for a pet?
No
Yes
If yes, where else have you applied for a pet?
Is this pet for you or someone else?
Myself
Someone else
Do you own other pets at the current time?
No
Yes
If yes, please list their names, breeds, and ages.
Are all of your pets spayed/neutered/fixed?
Yes
No
N/A
How many pets have you owned in the last 5-10 years?
What happened to them?
Are your pets current on their vaccinations?
Yes
no
n/a
Have you ever turned your dog or cat into a shelter?
No
Yes
If yes, please explain?
Veterinarian's Name
Veterinarian's Address, City, State, and Zip Code
Veterinarian's Phone Number
Have you ever had a pet euthanized?
No
Yes
If yes, please explain:
How do you feel about having pets spayed/neutered?
Agree
Disagree
Not Sure
Are you familiar with heartworm and heartworm prevention?
No
Yes
If you have pets, will they adjust to a new pet in the house?
Yes
No
Unsure
N/A
Were any of your pets obedience trained?
Yes
No
N/A
Please check the main reason you plan to adopt a pet:
Companion
Family Pet
Child's Pet Guard Dog
Companion for another pet
Other
If you answered "other" above, please explain here:
Please describe in detail the pet you are looking for.
Do you own or rent your home?
Own
Rent
Someone else owns the Home
Someone else rents the Home
Please select your current residence type.
House
Apartment
Condo
Townhouse
Mobile Home
Other
If you answered "other" above, please explain here:
How long have you lived at this address?
Less than one month
1-2 months
3-6 months
6-9 months
9-12 months
1-2 years
3-5 years
6-10 years
10 + years
If you rent, does your landlord and lease allow pets?
Yes
No
Unsure
N/A
Including yourself, how many people live in your household?
Please list the ages & relationship of those who live in your home.
Is everyone in your household aware that you are planning to adopt a pet?
Yes
No
N/A
Does anyone in your household have allergies to dogs/cats?
Yes
No
Possibly
N/A
Employment Status
Full-Time
Part-Time
Retired
Work from Home
Stay at Home Parent
Student
Unemployed
Other
If you chose "other" above, please explain:
If you are employed, what is your current occupation?
On average, how many hours per day will your pet be left alone?
How much do you think the annual medical bills will be for your pet?
About $100
$100 - $200
$200 - $300
$300 - $500
$500 +
What would you do if the bills went over this amount?
Will this pet be predominantly living inside, outside, or both?
Inside
Outside
Both
Please provide a description of this pet's living conditions.
Do you have a completely fenced-in yard? If so, what kind of fence?
Wood
Chain Link
Electric
Plastic
Iron
Other
Other (I do not have a fenced yard)
If you answered "other" above, please explain:
If you do not have a fenced yard, how will you let the animal out?
Are there times when the animal will be tied/chained up?
Yes
No
N/A
If yes, when will they be tied/chained up?
Where will the animal sleep?
In bed with me
In bed with my child
In a dog / cat bed
In a kennel / crate
Wherever he or she likes
Outside
Other
If you answered "other" above, please explain:
Will the animal spend any time in the garage?
Yes
No
N/A
If the animal will spend time in the garage, please explain when/why:
How will you handle housebreaking?
How will you handle destructive behavior?
Will you keep the animal up-to-date on vaccinations and heartworm preventative?
No
Yes
If no, please explain:
Are you willing and able to exercise the dog on a regular basis?
Yes
No
N/A
If yes, what is the method of exercise?
Walking
Running
Dog Park / Dog Run
Other
If you answered "other" above, please explain:
Have you ever been convicted of abuse or neglect of a child or animal?
No
Yes
If yes, please explain:
If you drive a pick up truck, would you allow the animal to ride in the back/bed?
Yes
No
N/A
What arrangements will you make for the care of your pets in case of an emergency?
Leave with family/friend
Boarding
Pet Sitter
Take with me/us
Other
If you answered "other" above, please explain:
What will you do with the animal when you go on vacation?
Leave with family/friend
Boarding
Pet sitter
Take with me/us
Other
If you answered "other" above, please explain:
For what reason(s) would you consider returning/giving up the animal?
What would you do with your animal if you had to move?
Take him / her with me
Give to family or friend
Return to shelter
Other
If you answered "other" above, please explain:
Are you willing to take responsibility for this animal for the next 10-20 years?
No
Yes
If no, please explain:
Will you allow us to perform home checks?
No
Yes
Please list two personal references (names and phone numbers) who are NOT related to you and can speak on your character and how you would be as a pet owner.
I have read the foregoing and certify that the answers I have given are complete, true and not misleading in any way. I am also aware that TCAS cannot guarantee the health and temperament of the animal.
*
I agree
I disagree
Do you authorize TCAS to confirm any information provided on this application with any appropriate third-party source, including landlords, veterinarians, personal references, etc? The information obtained will remain confidential and will be used by TCAS only for the purposes of evaluating the adoption application.
*
No
Yes
I understand that TCAS will consider the best interest of the animal when selecting an adoption placement. Thia means that TCAS may suggest a different animal if my first choice is not a good fit, and the TCAS reserves the right to deny any application for adoption at the discretion of the organization.
*
I agree
I disagree