General Information |
Primary Applicant's Last Name:
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Primary Applicant's First Name:
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Home Phone Number:
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Co-Applicant's Last Name:
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Co-Applicant's First Name:
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Cell Phone Number:
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Street Address:
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City:
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State:
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Zipcode:
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Email Address:
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Birthdate (MM/DD/YYYY):
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Number of Years at Residence:
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Have you ever adopted at this shelter?
Yes
No
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Interested in adopting...
Dog
Cat
Other
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Compatibility Information |
Is anyone in your household allergic to animals?
Yes
No
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Are all persons in your household aware you are applying for a pet?
Yes
No
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How many children are in the home?
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What are their ages?
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Who is this pet for?
Myself
My Family
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Type of Dwelling?
House
Apartment
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Do you own or rent?
Own
Rent
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If renting, what is your landlord's name?
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Landlord's number?
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Where will your pet be kept?
Inside
Outside
Both
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Fenced yard?
Yes
No
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Please list current and other animals you have owned in the past. |
Pet #1Breed of Pet:
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Name of Pet:
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Male or Female:
Male
Female |
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Is the pet spayed/neutered? Yes
No |
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If no, why?
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Still with you? Yes
No |
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If no, why?
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Pet Age:
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Pet #2Breed of Pet:
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Name of Pet
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Male or Female:
Male
Female |
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Is the pet spayed/neutered? Yes
No |
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If no, why?
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Still with you? Yes
No |
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If no, why?
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Pet Age:
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Pet #3Breed of Pet:
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Name of Pet:
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Male or Female:
Male
Female |
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Is the pet spayed/neutered? Yes
No |
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If no, why?
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Still with you? Yes
No |
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If no, why?
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Pet Age:
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Veternary Information |
Current Veterinarian or Veterninary Clinic/Hospital:
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Vet Phone Number:
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Name on the Vet Account
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Personal References |
Reference #1 Full Name:
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Reference #1 Phone:
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Reference #1 Additional Information about Reference:
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Reference #2 Full Name:
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Reference #2 Phone:
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Reference #2 Additional Information about Reference:
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Reference #3 Full Name:
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Reference #3 Phone:
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Reference #3 Additional Information about Reference:
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Emergency Contact Information |
Emergency Contact Full Name:
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Emergency Contact Phone:
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By typing my name and date below, I authorize Northwoods Animal Shelter to contact my veterinarian, lanlord, personal references, and anyone else necessarry to confirm how I have cared for animals and validate authorization for owning a pet. |
Type name for signature:
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Type date for signature:
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