* ***** ******, ***.

ADOPTION APPLICATION

Date

Name or type of pet applying for:

Name:

Phone (H):

Phone(W):

E-mail Address:

Employer:

Significant Other Name:

Employer:

Phone (w):

E-mail Address:

Reference (Name/Phone):

Address:

City:

Zip Code:

How long have you lived at this address?

How did you hear about 9 Lives Rescue?

Gazette

Coworker

TV

Friend / Relative

Website

Prior Adoption

Other:

1. List all pets owned (past & current) in the last five years:

TYPE

SEX

AGE

SPAYED/NEUTERED

WHERE IS THIS PET?

If not within last five years, have you ever owned this type of pet?

How long ago?

2. Why do you want to adopt this animal?

Companion

For Children

Gift

Other

3. How many adults are in your family / house?

Children?

Ages of Children

4. If there are no children, do you expect this to change during this pet’s lifetime?

5. Who will be responsible for feeding, housebreaking & training?

6. Does any member of your family have allergies to animals?

7. Is someone home during the day?

Who?

8. How many hours will this pet be alone during the day?

9. When I am home, this pet will be kept:

House/Garage/Basement/Yard/Outdoor Kennel/Crate

(higlight one)

10. When I am away, this pet will be kept:

House/Garage/Basement/Yard/Outdoor Kennel/Crate

(highlight one)

11. Where will this pet sleep?

Will the pet be allowed on the furniture?

12. Do you live in a:

House Townhouse Apartment Duplex Condo Mobile Home Military

a) Do you:

Own

Rent

Landlord’s name and phone

12a.. Is your

current or

previous cat: indoor

Indoor/outdoor

outdoor

12c.

Are you looking for a de-clawed cat?

If you have had a cat, is /was it de-clawed?

Do you plan on de-clawing your cat?

Why?

13. Are you looking for an

indoor, outdoor, indoor / outdoor

pet?

14. Which reasons are acceptable reasons for giving up your pet(s)?

Illness of animal Moving locally

Moving out of state/country Illness of owner Biting Pregnancy Allergy Stealing food

Kitten / Puppy destructiveness Litter box problems Scenting New baby Too Active

Scratching Compatibility with other pets Hides for first week Housebreaking accidents Chewing

Fence jumping Growling Showing Teeth Submissive peeing

15. Have you ever had to give up a pet?

When?

Why?

16. It may take your new pet a month or longer to adjust to its new home. What will you do if your pet displays

Undesired behavior(s) (see #14 for examples) during this adjustment time?

17. If you have a pet now, who is your veterinarian?

18. How much time will you spend with this pet each day?

19. What will you do with the pet during this time?

20. Are you familiar with local animal control laws & ordinances?

21. Do you know that cats / dogs require yearly vaccinations?

22. If you go away for a few days, who will care for this pet?

23. If you move (either locally or out of state or country), what will you do with this pet?

24. If you can no longer care for this pet, what will you do with it?

25. Do you plan to place personal ID tags on your pet?

26. How long do you expect to keep this pet?

27. You will likely get a follow-up call, e-mail, or a home visit from a 9 Lives volunteer to make sure everything

is going well with your new pet. Will this be a problem?

I, the undersigned, have answered all of the above questions truthfully and to the best of my

knowledge.

Signature

In order to determine whether this proposed adoption is in the best interests of both you and the animal, we ask that you answer the following questions carefully and completely. We reserve the right to refuse any adoption. A refusal does not reflect on you as a person, but simply means that the pet would not be suited to the circumstances that you offer. We feel that our knowledge of the animal, must be our guide in making the adoption decision.

12b. Do you have a dog door? Yes No

Contact this candidate