ADOPT A PET Adoptable Pets This page is powered by Shelterluv. Learn more at www.shelterluv.com Adoption Application Form Please fill out the form below to apply for the adoption of one of Mountain Shelter’s pets. Microchip # Pet Name: * Date * MM DD YYYY Name * First Name Last Name Home Phone # (###) ### #### Cell Phone # * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Email * Employer: * Employer Phone # * (###) ### #### Date of Birth * MM DD YYYY Driver's License # * State * Type of Housing * Own Rent If renting, Name of Landlord: Phone # of Landlord (###) ### #### If renting, are you aware of any deposits that are required for your pet? Yes No Does your lease/rental agreement allow for pets? Yes No Are there certain breeds of dogs or weight restrictions that are not allowed? How many children are in your household? * If yes, what are their ages? * How long have you lived at your current address? * Are you planning on moving in the near future? * Yes No Why do you want to adopt this pet? * What other pets do you have in your home? * How long have you owned these pets? * Are they spayed or neutered? * Yes No If no, why not? If they are cats, are they declawed? * Yes No Where do your pets sleep? Where are your pets kept during the day? Where are your pets kept in the evening? Where will your new pet sleep? * How long will your pets be alone each day? * Where will the pet stay? * Do you have a fenced in yard? * Yes No If yes, what is the size of your fenced in area? What will you do with your pet when you travel? * How often do you travel? * How will you provide exercise for the dog? * How will you provide toilet for the dog? * How will you train your pet? * If your living situation changes (such as divorce, relocation, death), who will be responsible for the care of this pet? * Please explain any recent deaths and ages of any of your pets? * Will you be able to financially provide care for this animal? Such as vetting, food, preventatives (ie. Heartworm & Flea Prevention) * Yes No Would you allow a representative of Mountain Shelter Humane Society to make a home visit? * Yes No For the protection of Mountain Shelter Humane Society animals, will you allow us to call your previous Veterinarian for references? * Yes No Veterinarian/Clinic Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### I certify that the above information is accurate and complete to the best of my knowledge. I understand that Mountain Shelter Humane Society has the right to reclaim the animal if any information is false and/or if the animal is not being properly cared for. I authorize the release of veterinary information related to current and past pet that I have had. This application is the property of Mountain Shelter Humane Society. Sign Your Name Here * Date of Signature * MM DD YYYY Thank you! Change Lives, Give Today DONATE
