Adoption Application

PUBLIC ANIMAL WELFARE SERVICES

Applicant's First Name *
Applicant's Last Name *
Street Address and Apt. # *
City *
State *
Zip Code *
Phone Number * Please use the following format 248-555-1212
Email Address * Please enter correctly as this is the main way we will contact you
Driver's License Number *
Select Choose File and Take Picture of your Driver’s License *
Who are you interested in adopting *
Do you Own or Rent? *
Have you or someone in your household ever been issued a citation for your pet(s) or had to reclaim your pet from an animal control or shelter? *
I have read the foregoing and certify that the answers I have given are complete, true and not misleading in any way. I am authorizing you to contact landlords, associations and veterinarians. You are also aware that we cannot guarantee the health and temperament of the animal. *
Signature *