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Paige
Paige
If interested in learning more or adopting, please complete and submit the application below.
Adopted March 2022
Female
Shih Tzu
2 to 3 yrs
UTDĀ on vaccines
Spayed
Microchipped
Adoption Application
Name
First
Last
Spouse/partner Name
First
Last
Address
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email
Phone
Secondary Phone
List Children (ages) and/or others living in the home:
Do you currently have pets?
Yes
No
What type of pets do you currently have?
Dog
Cat
Bird
Reptile
Rodent (Hamster, Rabbit & etc)
Farm Animals (pig, horse, goat & etc)
Other
List each current pet's name, species, breed, age, spayed/neutered, and temperament:
Are all current pets up to date on vaccinations & parasite control?
Yes
No
Please explain why they are not up to date:
Has your bird been checked for any communicable diseases?
Yes
No
Are all pets currently on heartworm preventative?
Yes
No
Please explain why they are not on heartworm medicine:
Tell us about the pets that you have had in the last 10 years. Name, age, breed, species, and if applicable, why you no longer have them:
Rent or own your home?
Rent
Own
Type of residence:
Area:
City
Suburban
Rural
Farm
Does your landlord allow pets?
Yes
No
Explain any restrictions on pets for your place of residence:
Landlord Name
Landlord Phone
Who will be the pet's primary caretaker?
Myself
Veterinarian's Name (Please call your vet to give permission for a vet reference if they require that)
Veterinarian's Phone Number (Application process may be delayed without this information)
What species are you interested in adopting?
Dog
Cat
Bird
Reptile
Rodent (Guinea Pig, hamster, rabbit & etc)
Farm Animal (Pig, horse, goat & etc)
Pet(s) of interest:
Will your cat spend time outdoors?
Yes
No
Explain outdoor activities:
Do you plan to declaw your cat?
Yes
No
Have any of your previous cats been declawed?
Yes
No
What type of play opportunities will your cat have?
What type of litter will you use?
Home description (in particular what areas of your home will be available to your bird)?
What species of bird(s) are you primarily interested in and why?
Does anyone in your household smoke?
Yes
No
Who would take care of your bird when you are not available (travel, illness, etc)?
What activities do you plan to do with your bird?
Does your home have a yard?
Yes
No
Is the yard fenced?
Yes
No
Please describe the yard feature and fence height etc:
Where will your pet spend most of his/her time?
How many hours per day will your pet be left alone?
Where will your pet spend time when left alone?
How do you feel about crating your dog?
How do you plan to exercise your dog?
What activities do you plan to do with your dog?
Where will your pet sleep at night?
What type of food will you feed your pet?
What brand of food?
List any circumstances that would cause you to not keep your pet:
Anything else you would like to share:
Reference #1 Name
Reference #1 Phone
Reference #2 Name
Reference #2 Phone
Reference #3 Name
Reference #3 Phone
I hereby state that the information on this application is true and correct to the best of my knowledge.
I am at least 18 years of age
Signature
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