I am interested in a:
*
Animal Name assigned by shelter, if applicable
*
Adopter's Name
*
First Name
Last Name
Adopter's Birthdate
*
MM
DD
YYYY
Animal Age, if available
*
Animal Species (Canine, Feline, Other)
*
Home Phone Number
(###)
###
####
Cell Phone Number
*
(###)
###
####
Residential Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
How long have you lived at this address?
*
Are you planning to move in the next year?
*
Do you rent or own your home?
*
Does your rental agreement or condo association allow you to have animals?
*
Are there dog breed restrictions on your home’s insurance policy?
Is your home part of an HOA or Condo Association?
*
If yes, what are the requirements and/or restrictions for pet ownership?
*
Who lives in your home?
*
Do children live in your home?
*
If yes, what are their ages? If not applicable, typ N/A
*
Are you employed?
*
Employer Name
Your Position/Title
How long have you been employed here?
Employer Phone Number
(###)
###
####
Employer Contact
Please list income source(s):
Is everyone in agreement to adopt a new pet?
*
Do you have other animals?
*
If yes, list animal species, name, age and if spayed or neutered:
If you have ever owned a pet before, please list name and phone number of your veterinarian. Whose name are the vet records under? Please call the practice to grant us permission to conduct a reference.
Please list a personal reference that is not related to you and has been to your home..
*
Please include name, contact information, relationship, and how long you have known each other.
Have you ever owned a dog, cat, or small animal before?
*
If yes, please list all pets you have had in the past.
Please use a new line for each pet. Please include the following information: 1. Current or Past Pet 2. Name 3. Species/Breed 4. Spayed/Neutered? 5. Owned how long?
Are/Were all current/past pets up to date on vaccines and preventative medications?
*
Please tell us about your past pets and why they are no longer with you.
*
Examples: Pet is deceased, given away, surrendered, sold, etc.
Have you applied to adopt an animal from the Marshfield Animal Shelter before?
*
I am adopting this pet as a:
*
I have chosen to adopt this particular pet because:
*
The most important thing I want in a pet is:
*
Is there a situation in which you would not be willing or able to keep this pet?
*
Is there anyone who will take the animal if you are no longer able to care for it? If so, please provide their name and contact phone #.
*
Approximately how much do you expect to spend on your pet every month? (Food, vet care, etc.) Are you able to provide annual wellness vet visits for your pet, including rabies and other vaccines?
*
I consider my home to be:
*
My pet will be alone:
*
Do you want an active pet?
*
I want my pet to enjoy being held.
*
I want my pet to live:
*
My pet needs to be comfortable with:
*
My pet needs to be able to adjust to new situations quickly.
*
How much time are you willing to give your pet in order to adjust to their new home?
*
Please indicate any topics you would like to discuss further.
If there is a topic you would like to discuss not listed above, please write the topic here.
Please type your full legal name (this will serve as your signature.)
*
Date of application
*
MM
DD
YYYY
Adopter's Email Address
*
