Pet Adoption Application (Page 2 of 3) in pdf

Pet Adoption Application Page 2

who will own & care for the

pet?__________________________________________________

Where will the pet be kept? Check all that will apply: doghouse in pen_____

doghouse in________________________

fenced yard_____ doghouse with chain_____ Shed/Barn/Garage_____

Other____________________________________________________

Reason for wanting this

pet?____________________________________________________

How many hours a day would this pet be left

alone?________________________________

Does anyone in your household have any allergy to animals? yes____ no____

Name & city of your Veterinarian (s)

_____________________________________________

Vet’s phone #__(______) _____________________________________________

List any cats/dogs you have owned in the last two years:

Pet’s Name

Cat Dog Breed

Age

Sex

Spayed/Neutered? Still have?

_____________________ ___ ___ __________ ____ ____

Yes___ No____

Yes___No___

_____________________ ____ ____ __________ ____ ____

Yes ___ No ____ Yes___ No___

List three references including addresses:

______________________________________________________________________________________

Have you ever surrendered an animal to a shelter? ___________ Pet___________ Stray_________

Are you familiar with the Animal Control ordinances in your area – yes or no – concerning:

Licensing:__________ Shots: ____________ Leash Laws: ___________

Do you agree to the following?

Yearly vaccinations_____, Spaying/ Neutering ____ , Heartworm medications for dogs____

Would you agree to your home being inspected by a GCHS representative? ________

Pet Adoption Application Page 2