Please provide the following contact information:

Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Work Phone
Home Phone
FAX
E-mail

Name or description of pet(s) in which you are interested:

Your age:

Ages of children in household:

List pets currently in your household.  Please include names of pet(s):

Are your current pets spayed/neutered and current on all vaccinations?

List previous pets (include names) and what happened to them:

Are you a renter or a homeowner?  Please state whether you rent/own a single-family home, multi-family or apartment/condo.

If you are a renter, please provide landlord's name and telephone number so that we may confirm permission to keep a pet:

Do you have a yard and, if so, is it fenced on all sides?

If you have a fenced yard, what height is the fence?

Where will the pet be kept when you are at home?  Where will the pet be kept when you are away from home?

Where will the pet sleep at night?

How will you provide for the pet's exercise/toilet needs?

How many hours a day will your pet be left alone?

If you are adopting a dog, are you prepared to housebreak it? If so, what method will you use?

What obedience training, if any, will you provide?

If you are adopting a cat, do you plan to de-claw it? If so, please describe the de-clawing process.

What do you estimate is the yearly cost of food, supplies and emergency and routine veterinary care?

Please provide the name and telephone number of your veterinarian.  If you are interested in adopting a poodle or other dog requiring grooming, please provide your current groomer's name and telephone number as well.

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