Have you adopted from us before? Yes No
If yes, when and which animal?

Have you ever surrendered a pet to this or any other shelter?
Yes No
Why?

What is your reason for adopting a pet?
Companion for another Pet? Family Pet
Child’s Companion Adult’s Companion

What type of pet are you interested in?
Active and playful Watch dog (would bark to alert)
Couch potato and quiet Guard Dog (would bite if provoked)

Where will the pet stay the majority of the time?
Loose in home Crated inside home
Confined to an area of the house
Outside, describe enclosure including shelter provisions?

Where will the pet stay when the family is gone?
Loose in home Crated inside home
Confined to an area of the house
Outside, describe enclosure including shelter provisions?

Do you: Rent Own
If you rent, please list Landlord's name and phone number
Landlord's Name: Phone:

How many hours a day is someone home?

Is the yard fenced? Yes No
If yes, what type of fencing?
Chainlink Privacy Other
If no, please describe how your animal will get excercise?

Briefly describe your home:

Is this your first pet ownership experience? Yes No
If no, please tell us about all pets you have have owned in the past 5 years:

Pet's Name	Type of Pet	Spayed/ Neutered	If you still own the animal, how old?	If you no longer have the animal, what happened to it? At what age? When?
	Cat Dog	Yes No
	Cat Dog	Yes No
	Cat Dog	Yes No

What food(s) are you currently feeding your other pets?

How much money would you plan to spend yearly on your pet?
$100-$200 $200-$300 $300-$500 Over $500

If you had to give up your pet would you?
Take it to the nearest shelter
Give it to a friend or relative
Return it to the rescue group

List your current or most recent veternarian's name and phone number:
Name: Phone number:
How long have you been a client?