Pre Adopt Form
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1
2Northeast Animal Shelter
This box is for o ce use:
NEAS #
Date:
_____________________
________________
Pet’s Name
Pre-Adopt Form – Helping Us Help You!
______________________________________
[ ] Still looking; call if nd candidate.
Please clearly PRINT your info on this form to help us nd the best match for you.
AC:
__________________
ABOUT YOU
__________________________________________________________________________________________________________________________________________________________________________________________
Name ↑
Your Email
__________________________________________________________________________________________________________________________________________________________________________________________
Street ↑
City
State
Zip
__________________________________________________________________________________________________________________________________________________________________________________________
Phone ↑
Other Phone
Work Phone
ABOUT YOUR HOME
Do you own or rent your home?
[ ] Own
[ ] Rent
How long at this address?
Are you planning to move? [ ] Yes
[ ] No
If Yes, when?
___________________
_______________________________
If you rent your home, does your lease allow pets? [ ] Yes, cats only
[ ] Yes, cats and dogs [ ] No
Restrictions (e.g., breed, weight, landlord’s OK):
__________________________________________________________________________________________________________
Landlord’s Name & Phone:
_______________________________________________________________________________________________________________________________________
How would you describe your home?
[ ] Single family house
[ ] Multi-family house
[ ] Condo
[ ] Town house
[ ] Apartment
[ ] Mobile home
What is your household activity level? [ ] Quiet as a library
[ ] Grand Central Station [ ] Somewhere in between
Rate your comfort level with pets:
[ ] First-time owner
[ ] Have had 1 or 2
[ ] Knowledgeable and experienced
If you do not have children living at home, do any children come to visit?
[ ] Yes
[ ] No
List all the people who will be living with the new pet? (Please list names, ages, and relationship.)
__________________________________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________________
Who will the new pet be for?
[ ] Myself
[ ] My family
[ ] Other:
""_____________________________________________________________________
Who will be the primary caregiver? [ ] Myself
[ ] My family
[ ] Other:
""_____________________________________________________________________
Is anyone living in your home allergic to cats or dogs? [ ] Yes , cats
[ ] Yes , dogs
[ ] No
☞
NOTE: Children in the home should accompany you if you are planning to adopt a puppy or dog.
If adopting an adult dog, the Shelter requires any other adults in your home to meet and approve the dog
prior to finalizing the adoption.
For puppies, verbal approval by phone is acceptable.
ABOUT YOUR EMPLOYMENT
Where are you employed?
__________________________________________________________________________________________________________________________________________________________________________________________
Business Name ↑
City & State
Work hours
Phone
Where is spouse or other adult employed?
__________________________________________________________________________________________________________________________________________________________________________________________
Business Name ↑
City & State
Work hours
Phone
REFERENCES
Check the box on right if this reference would be good for emergency contact in case your pet is lost and we can’t reach you.
[ ]
__________________________________________________________________________________________________________________________________________________________________________________
Name ↑
City & State
Phone
[ ]
__________________________________________________________________________________________________________________________________________________________________________________
Name ↑
City & State
Phone
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