Adoption form

Your name

Address

Phone Number

Your email

Do you own or rent your home? If renting, landlord’s name and phone number:

Rent

Own

Your answer

Type of residence

Do you currently have any pets?

Yes

No

If yes, please list: Species/Breed: Name: Age: Spayed/Neutered: Up-to-date on vaccinations:

Have you had pets in the past 10 years? If yes, what happened to them?

yes

no

Your answer

Do all members of your household agree to this adoption?

Yes

No

Does anyone in your household have pet allergies?

yes

no

other

Your answer

Number of adults in the home: Number of children:

What type of pet are you looking to adopt? Dog? Cat? Other?

Dog

Cat

Other

Your answer

Reason for adopting a pet:

How many hours per day will the pet be left alone?

Where will the pet stay during the day?

Where will the pet sleep at night?

Are you financially able and willing to provide annual checkups, vaccinations, emergency medical care, and daily care for your pet?

yes

no

Are you prepared to care for this pet for its entire life (10–20 years)?

yes

no

Other

Are you willing to work through behavior challenges, if any arise?

yes

no

Have you ever surrendered an animal to a shelter,If yes, please explain: shelter or rescue?

Is there anything else you’d like us to know about you, your home, or your experience with pets?

Please provide two references (non-family members):

I understand that false or misleading statements can result in denial of the adoption.

I authorize Pets Love Vets to contact my references, landlord, and veterinarian as needed.

By signing below, I certify that the information I have provided is accurate and complete.

Applicant Signature: Date: