COMPANION ANIMAL ADOPTION APPLICATION

Date:



APPLYING FOR:

Name of Animal:
Age:

ID number:

APPLICANT'S INFORMATION:

Full Name:

Address:

City:

State:

Phone Number:

Age:



HOUSEHOLD INFORMATION:

Where Do You Live? (Please leave one option)
House
Condo/Apt.
Mobile Home
Student Housing
Military Housing

Neighborhood (Please circle one): Urban / Suburban / Rural

How long at your present address?

Do You Own Your Own Home? Y/N (If yes, please provide proof of ownership.)

Do you rent? Y/N
If yes,
Landlord's Name:
Landlord's Phone Number:

Are you planning to move within the next year? Y/N
If yes, what are your plans for your companion animal when you move?

If you decide to move in the future, what will you do with your companion animal?

What provisions have you made for your companion animal in the event of your illness or death?



How many adults in your home?

Are there children in your home? Y/N
If yes, what are their ages?

Are all members of your household aware of your plans to adopt an animal? Y/N

Are any members of your household allergic to animals? Y/N

Where will your companion animal sleep?


How many hours will your companion animal be alone?

Who will be responsible for the animal?


Do you have any health conditions which could restrict your ability to care for an animal? Y/N
If yes, please describe:





VACATION:

How often do you go on vacation?

Who will care for your companion animal when you go on vacation?




EMPLOYMENT:

Applicant, How long at your present job?

Other adult in home, How long at your present job?


OTHER ANIMALS:

Do you have cats? Y/N
If yes,
How many? Do the cats live strictly indoors? Y/N
Are the cats declawed? Y/N

Do you have dogs? Y/N
If yes,
How many?
Do dogs live indoors? Y/N

Other animals? Y/N
If yes,
How many?
Describe living conditions of other animals:
Are all animals in your household spayed/neutered? Y/N

Name of Veterinarian:
Address:
Phone Number:

If no companion animals at this time, have you had any in the past 10 years? Y/N
If yes, what happened to them?



REFERENCES:Please list people other than family who you have known for at least 5 years.

Name:
Phone Number:

Name:
Phone Number:

Name:
Phone Number:


QUESTIONS:

Why do you want to adopt an animal?

What type of personality are you looking for?

(If applicable) Have you ever had a special needs animal before? Y/N
If yes, describe:

If necessary, how will you discipline the animal?



I hereby certify that all information supplied by me on this application is true.  By signing below I am aware that Canine Kids Relocation May contact any of the above references and give my permission for the above named parties to answer any questions that are asked of myself, family, or about past, current of future pets.

E-Signature:
Date: