Adoption Application

Address *

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City

State

Zip Code

Country

Occupation, employer name and how long employed. If self-employed, what is your occupation. If retired, prior occupation. If applicant is not working, list job of household provider. *

May we contact your employer to verify employment? Please provide name and number. *

Own or Rent? If renting, does landlord approve of pets? *

Would you agree to a home inspection? If no, please explain. *

List names and ages of other people who will be living with the pet: *

Choose One *

Pet will be in fenced yard Pet will be indoors only Pet will be leashed walked and indoors Pet will be tied out

Is this the first pet (other than a family pet)? If so, please provide name & phone number of two non-relative references. *

If adopting a cat, will it be declawed? *

Were all your other pets spayed or neutered? If not, please explain why. *

Have you ever given a pet to a shelter? If yes, please explain circumstances. *

Choose One *

Pet will have full access to home Pet will be confined to certain rooms Pet will be crated Pet will be outside

Please provide name, address and phone number of the veterinarian that is currently caring for your pets. Veterinary history is a very important aspect of pet adoption. You may need to call your veterinarian to give permission to speak to us regarding your pet's records. If you do not have history with a veterinarian, please provide three references of non-relatives we may contact. *

Please list all current or previously owned pets including age, breed and sex. Please specify if pet is deceased. Do not include family pets from your childhood. *

Name of pet you are interested in adopting *

Would you like to receive our newsletter? *

If you are approved for an adoption through Animal Lifeline, Inc., the understanding is that if for any reason the pet can no longer reside in your home the pet MUST be returned to Animal Lifeline, Inc. ONLY A.L.I. can place the pet into another home. Please enter your name in the signature boxes to indicate you understand this agreement.

Signature *

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Last

Please fill out the questionnaire to apply for adoption.