Pet Adoption Application Lee County Domestic Animal Services
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1
2PET ADOPTION APPLICATION
Lee County Domestic Animal Services
5600 Banner Drive, Fort Myers, FL 33912,
Phone: (239) 533-PETS
Fax: (239) 277-PETS
PLEASE PRINT LEGIBLY
First, Middle, Last Name
Home Phone (
)
-
Address
Cell Phone
(
)
-
City/St/Zip
Alter. Phone (
)
-
Drivers License #
Email
□ Cat
□ Kitten
□ Dog
□ Puppy
□ Senior Pet
□ Animal ID A_________
What pet do you wish to adopt?
If you are interested in adopting a puppy, there may be a 24 to 48 hour delay for supervisor review and approval.
□House
□Apartment
□Condo
□Townhouse
□Mobile Home
□Other __________
I live in a:
□Own
□Rent
□Live with Parents
□Live on Campus
□Other __________
I:
How long at present address? Years _____ Months_____
Do you plan on moving within 6 months?
□Yes □No
List all members living in household, including applicant:
ADULTS (First and Last Name)
DOB
AGE
CHILDREN NAMES
AGE
/
/
/
/
/
/
/
/
/
/
/
/
Are the adults in the household aware and approve of your plans to adopt a pet? □ Yes □No If no, why:
□Yes □No
Are you or a member of your household a law or code enforcement officer protected by F.S. 119?
PET HISTORY: Please list all pets currently in your household and/or owned in the past ten years.
Name
Breed
Age
Sex
Inside/
Where did
Time
Where is pet
Rabies Vac
S/N?
Outside
you get pet?
owned?
now?
Current?
Name of current Veterinarian or Veterinarian Clinic:
Do you plan on spaying/neutering your adopted pet? □Yes □No If no, why?
Have you ever surrendered an animal to a shelter under any circumstances? □Yes □No If yes, please explain:
Where will the pet be housed during
Where will the pet be housed over
How many hours a day will the pet be
the day?
night?
left unattended?
How will you keep pet confined on your property?
How often do you have your pet vaccinated for rabies? ____________________________________________________
How often do you have your pet licensed with Lee county? _________________________________________________
Do you allow your pet off-leash? □ Yes □ No If yes, explain:_____________________________________________
(See Other Side)
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