COMPANION CRITTERS, INC.
SMALL ANIMAL ADOPTION APPLICATION
The following information is requested so we can assist you in the selection of a new pet. The animal's welfare is our foremost concern. The consultation process is designed to help us assist you in finding the animal most compatible to your lifestyle.
Please complete all of the information on the application. We regret that incomplete applications cannot be considered. Please give careful consideration to adopting a pet. Animals are not short-term commitments. Make sure your lifestyle allows the time, patience and expense this pet will need over the years. Animals for adoption are placed with full consideration given to the specific needs of each animal
Name of pet for which applying:
The reason I would like to adopt this particular pet:
Are you over 18 years of age?
I am adopting for
I am prepared to adopt this pet
PLEASE NOTE: If you checked off later than "1 week from now" please check back when you are ready to adopt and apply at that time as we do not have the space to hold animals.
Name of Person(s) Applying to Adopt:
Address.
City:
State:
Zip Code:
Home Phone:
Work Phone:
Cell Phone:
Email Address:
Is this your first experience with a pet?
Do you currently have any pets in your home?
*If yes, please complete for each pet:
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Pet #1 is a
Name:
Age:
Breed:
How long have you had this pet?
Is this pet up to date on vaccinations?
What brand heartworm preventative do you use?
What brand flea/tick preventative do you use?
This pet is a
This pet spends
% time indoors
% time outdoors
Please tell us about this pet
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Pet #2 is a
Name:
Age:
Breed:
How long have you had this pet?
Is this pet up to date on vaccinations?
What brand heartworm preventative do you use?
What brand flea/tick preventative do you use?
This pet is a
This pet spends
% time indoors
% time outdoors
Please tell us about this pet
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Pet #3 is a
Name:
Age:
Breed:
How long have you had this pet?
Is this pet up to date on vaccinations?
What brand heartworm preventative do you use?
What brand flea/tick preventative do you use?
This pet is a
This pet spends
% time indoors
% time outdoors
Please tell us about this pet
If there are currently more than 3 pets, please list the same information as above for the others:
Have you had any pets in the past?
*If yes, please complete:
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Past Pet #1 was a
Name:
Age:
Breed:
How long did you have this pet?
Was this pet up to date on vaccinations?
What brand heartworm preventative did you use?
What brand flea/tick preventative did you use?
This pet was a
This pet spent
% time indoors
% time outdoors
Please tell us what happened to this pet:
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Past Pet #2 was a
Name:
Age:
Breed:
How long did you have this pet?
Was this pet up to date on vaccinations?
What brand heartworm preventative did you use?
What brand flea/tick preventative did you use?
This pet was a
This pet spent
% time indoors
% time outdoors
Please tell us what happened to this pet:
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Past Pet #3 was a
Name:
Age:
Breed:
How long did you have this pet?
Was this pet up to date on vaccinations?
What brand heartworm preventative did you use?
What brand flea/tick preventative did you use?
This pet was a
This pet spent
% time indoors
% time outdoors
Please tell us what happened to this pet:
Have you ever taken a pet to a shelter or had to rehome your pet?
*If yes, please describe the circumstances:
Who is/was your veterinarian?
Name of veterinary practice:
Address of veterinary practice:
Phone number of veterinary practice:
Approximately when was your last visit:
Under who's name (pet's owner) are the pet's records?
Do we have your permission to contact your veterinarian?
You currently live in a
How long have you resided at this address?
You currently
* If you rent, are pets allowed?
Landlord's name:
Landlord's phone number:
May we contact your landlord?
** If you live at home with your parents, do you have your parent's permission to adopt?
What would you do with your pet if you had to move where pets aren't allowed or if you were no longer able to care for your pet?
Under what circumstances would you find it necessary to give up your pet?
How many people live in your household?
Is everyone in the family in agreement with adopting a pet?
How many children live in the household and what are their ages?
Who will have primary responsibility for the care of this pet?
If children (any household member under 18) are expected to have responsibilities, please describe to what extent.
Does anyone in your household have allergies to animals?
Where will this pet be kept during the day?
Where will this pet be kept during the night?
Where will the pet be kept when left alone?
Is anyone home all day?
*If no, how many hours will the pet be left alone in a 24 hour period?
You would like to adopt this pet as a:
Family Pet
Companion
Gift
Breeder
Companion for another pet
Other:
Please tell us about your experience in caring for species you are applying to adopt (food and housing requirements in particular). If you have no previous experience, please explain your understanding of proper care requirements for this type of pet.
By signing below, you certify that you understand the following:
Companion Critters, Inc. reserves the right to refuse adoption to anyone.
The information contained within this application is accurate and not misleading in any way.
Companion Critters, Inc. reserves the right to contact individuals listed on this form for verification.
Would you be willing to let a representative from Companion Critters, Inc. visit your home by appointment?
Electronic Signature:
Date:
