Pre-Adoption Application Form

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th
239 50
Street, Moline, IL. 61265
309-797-6550
P
RE-ADOPTION APPLICATION FORM
APPROVED____DENIED _____ BY_________________________
(To be completed and returned to Animal Aid Humane Society for review)
Date ______________
POTENTIAL ADOPTER: Please fill in the pet’s name and type of animal (kitten, cat, puppy, dob, etc )
AAHS ID #. _____________on cage card.
Pet’s Name______________________ Type of Animal____________________________MC ID # _________________
Where did you see this pet:? Animal Aid ____ Petco Moline _____ Petco Davenport _____ Pet Smart_____ Other _____
1. PERSONAL INFORMATION
Name (first) _____________________(mi) ___________ (last) ___________________ Date of Birth________________
Employer____________________________________Fill in Driver’s License No.______________________________
Spouse/ ( in the home) Name (first)_______________________ (mi)________ (last)_____________________________
Date of Birth____________ Street Address________________________City_______________________ State_________
Cell Phone____________________Work Phone__________________
How long at this address?_______________
Do you live in a house ____ apartment ____ condo/townhouse ____ duplex ____ multiplex _____ mobile home _____
Do you own your home? Yes ___ No____
If you rent, do you have permission to have a pet?
Yes ___ No ___
Landlord’s Name Phone Number_____________________
How many adults live in your home?_________
Please list ages of children in your home. _______________________.
Do all members of your household agree to this adoption? Yes ______ No______
Who will be mainly responsible for the care of this pet?____________________________________________________
Are you a student? Yes ___ No____ {If under 18 and you live at home, we will need permission from your parent/legal
guardian for this adoption.} Parent/Legal Guardian's Name_________________________________________________
Phone Number_______________________________ Cell Phone Number__________________________________
Spouse's Employer_____________________________
2. GENERAL INFORMATION
Have you ever adopted any other pets from our shelter? Yes _____ No_____ If yes, when?___________________
Are you looking for an Indoor pet _______ Outdoor pet ______Indoor/Outdoor pet_______ Caged pet________
Do you mind if this pet requires grooming on a regular basis? Yes _____ No_____
Does having animal hair around the home bother anyone in your home i.e. allergies, asthma, etc.? Yes ____ No____

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