Test Form Pet Savers Adoption Application v.2 Please fill out all required fields Step 1 of 2 - About You 0% Name First Last Email Address Street Address Address Line 2 City State ZIP / Postal Code Phone 1Phone 2Name of Employer Employer PhoneLiving CircumstancesTell us about your home lifeHousing Type* House Condo Apartment Mobile Home Farm Do You* Own Rent Live with Family Live with Roommates Landlord's Name First Last Landlord's PhoneIs a pet deposit required?* Yes No How many adults live in your household?*123456 or moreHow many children live in your household?*0123456 or moreIf there are children, what are their ages? Are all members of your household supportive of this adoption?* Yes No Does anyone in your household have any known allergies to animals?* Yes No Are you active military duty?* Yes No Pet History What experience do you have with pets?Pet 1Name Cat or DogSelectCatDogSpayed or Neutered?SelectYesNoCurrent or previous pet?SelectCurrentPreviousPet 2Name Cat or DogCatDogSpayed or Neutered?YesNoCurrent or previous pet?CurrentPreviousPet 3Name Cat or DogCatDogSpayed or Neutered?YesNoCurrent or previous pet?CurrentPreviousPet 4Name Cat or DogCatDogSpayed or Neutered?YesNoCurrent or previous pet?CurrentPreviousIf none are listed above, is this your first experience with a pet?* Yes No Have you previously adopted from us or another agency/shelter?* Yes No Have you ever given away or returned a pet/animal for any reason?* Yes No If yes, why? Why do you want a pet? Family Pet Guard Dog As a friend for another pet Gift Other What is your other reason? Veterinarian InformationIt is REQUIRED that you have a vet before Pet Savers can adopt an animal to you. We will be contacting your veterinarian for basic records on current and previous pets (vaccine history, heartworm prevention). Your vet may require your permission to release this information. Please notify them we will be calling, otherwise your application may be denied.Name* First Last Name of veterinary hospital* Phone*What is the EXACT name you are listed at under your vet. We call and verify for all adoptions* First Last Information on current petsAre your pets current on their vaccinations?* Yes No Are your pets on heartworm preventative?* Yes No Please explain why heartworm preventative is important: Briefly explain how pets get heartworms. What brand of heartworm preventative do you use or have you used in the past? How often do you give heartworm medication? Pet DetailsWhat is the pet's name while at Pet Savers? Cat or DogCatDogFor Dog AdoptionsDo you have a fenced yard? Yes No How will you confine this pet to your yard? Where will the dog be kept during the day? Where will the dog be kept at night? How many hours a day will the dog be left alone? For Cat AdoptionsCat will be: Indoor Only Outdoor Only Combination Do you plan to declaw? Yes No Unsure Would you like information about alternatives to declawing? Yes No How many hours a day will the cat be left alone? Do you have a plan to introduce the cat to your household? Yes No Unsure ReferencesName of First Reference First Last PhoneEmail Name of Second Reference First Last PhoneEmail Statement of UnderstandingAdoption Agreement* I understand that the shelter environment often induces stress in animals. If the animal has behavior problems that I am not sure how to manage, I will contact Pet Savers for information and resources or seek professional assistance. I also understand that it may take 3-6 months for a pet to completely adapt to a new home and family. I understand the daily time commitment needed to properly care for this animal and am capable of providing such care. I understand that if I adopt a puppy that has not already been surgically sterilized, I must have the animal surgically sterilized before the animal reaches eight months of age and ideally at 5 months of age or Pet Savers may reclaim my pet. I understand that this is a lifetime commitment of 10-20 years and I am responsible for annual, monthly and unforeseen veterinary care, including monthly heartworm preventative. I understand, should I not be able to provide for his or her care, that I will not surrender, sell or otherwise list my pet as available for re-homing to anyone, without first consulting and notifying Pet Savers. I understand and agree to each of the previous statements. Select the checkbox to acknowledge your understanding.Consent* I agree to the Adoption Agreement.CommentsThis field is for validation purposes and should be left unchanged.