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While the data on this Web site is kept as up-to-date as possible, please
realize that the requested animal may or may not be available at the
time you submit your request. In addition, multiple requests for a given animal may be
in process at any time. Thank you for your understanding!
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Information About You (Fields in Bold Type are Required)
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| Name: |
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| I Am Age 21 or Older: |
Yes
No
(you must be 21 or older to submit this form) |
| Street: |
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| City,State,Zip: |
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| Email Address: |
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| Phone: |
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| How did you hear about us: |
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Information About the Animal You Wish to Adopt (Fields in Bold Type are Required)
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| Type: |
Dog |
| Name of Animal: |
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| If Not Listed, Enter Name: |
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Information About Your Current Residence (Fields in Bold Type are Required)
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| Do You Own or Rent: |
Own
Rent |
| Residence Type: |
House
Apt
Duplex
Mobile Home
Farm |
| How many members in household: |
Agree About Adding Pet:
Yes
No |
| Are there children in the house: |
Yes
No
List ages of children:
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| Does anyone in your household have pet allergies: |
Yes
No |
| Does anyone in your household smoke: |
Yes
No |
| (Dogs) Do you have a fenced yard: |
Yes
No |
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Information About Your Pets (Fields in Bold Type are Required)
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| Pets You Own: |
Dogs:
Cats:
Other:
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| Spayed or Neutered: |
Yes
No
Vaccinations Current:
Yes
No |
If you owned pets in the past, what happened to them?
Include any you have had to surrender, give away, or those who have passed from old age or illness: |
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Information About Your Veterinarian (Fields in Bold Type are Required)
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| Name of Vet: |
Phone:
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| Please list a reference not related to or living with you: |
Phone:
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If You Adopt This Pet... (Fields in Bold Type are Required)
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| Where will your pet sleep: |
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| (Cats) If you declawed pet cats in the past or plan to declaw this cat, explain why: |
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| (Cats) Will the cat you adopt be: |
Indoor Only
Indoor/Outdoor
Outdoor Only |
| What are your reasons for adopting a pet: |
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| How long are you gone each day and where will the pet stay while your are gone: |
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| Describe a typical day for this pet if adopted by you: |
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How often do you travel and
who will care for the pet while you are away: |
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| What type of flea control will you use, and how often: |
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| If you have another pet or pets, describe how you will introduce your new pet: |
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| Other Comments: |
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