Email address:
Your first & last name:
Spouse’s name:
Current Address: Apt #
City:
State:
County:
Zip Code:
Phone #

If applying for a particular pet, which pet?

1. How long have you lived at the above address?

2. What type of pet are you looking for?
Dog:
Puppy:
Cat:
Kitten:

3. Please check any of the following reasons for adopting this pet:
Family pet:
Child’s pet:
Watchdog:
Companion:
Breeding:
Hunting Dog:
Guard dog for business:
Barn Cat/Mouser:
Companion for Other Pet:
Gift:
Other:

4. Are you and/or your spouse currently employed?
Yes: No:

5. Are you 18 years of age or over?
Yes: No:

6. Do you live with your parents or other relatives?
Yes: No:

7. Are you interested in adopting for
yourself: family: someone else:

8. Do you own your own home?
Yes: No:
Do you rent?
Yes: No:
Do you live in a
House: Apartment: Condo: Mobile Home: Duplex: Townhouse:

9. Does your lease allow pets?
Yes: No: Not applicable:

10. What is your landlord’s name or the name of your apartment complex?
Landlord/Apartment Complex Phone #

11. How many people live in your household?

12. Do all members know that you plan to adopt a pet?
Yes: No:

13. What are the ages of any children/grandchildren in your household?

14. Does any member of the household have allergies?
Yes: No:If yes, describe:

15. Will an adult be in the home during the day?
Yes: No: Part-time:
What is the longest period of time the pet would be home alone on the average day?

16. Who will be responsible for taking care of your pet?

17. If adopting a dog or puppy, what procedures will you use for housebreaking?

18. If adopting a dog or puppy, how will you handle chewing, scratching, or other destructive behavior?

19. If adopting a cat or kitten, how will you handle scratching or destructive behavior?

20. Have you ever adopted from EVHS or from another shelter or rescue?
Yes: No: Where is that pet now?

21. How many cats and/or dogs have you owned in the past five years?
Dogs: Cats:
Where are those pets now? (be specific)

22. Have you ever turned in an animal to animal control or an animal shelter?
Yes: No: If yes, why?

23. Have you ever had to find another home for a pet?
Yes: No:
If yes, when and why?

24. Has a dog died on your premises of distemper, parvo, or unknown causes within the last three (3) months?
Yes: No:

25. Has a cat died on your premises of distemper, leukemia, or unknown causes within the last three (3) months?
Yes: No:

26. Do you currently own a pet?
Yes: No:
Please list all animals with name, age, breed:

27. Do your pets live
indoors: outdoors:

28. Are their shots up to date?
Yes: No:

29. If you currently own a dog, is it on heartworm preventative?
Yes: No: What kind?

30. Are they spayed or neutered?
Yes: No: If no, why not?

31. Do your pets currently wear ID tags?
Yes: No:

32. Would you object to having your new pet spayed or neutered?
Yes: No:

33. Are you willing to go to the expense and trouble of taking your pet to a veterinarian for full preventative and medical care, including shots, heartworm preventative, flea treatment, grooming, quality food, and emergencies?
Yes: No:

34. What is the name of your veterinarian or veterinary clinic? Phone #

35. Will your new pet live
inside: outside: Where will your new pet sleep?

36. Will pet have access to the entire house?
Yes: No: If not, where will pet be allowed?

37. Is there a yard available?
Yes: No:
How large is your yard? :
Is the yard completely fenced?
Yes: No:
How tall is the fence?
Is there a dog house?
Yes: No:
Do you plan to use a pen? Yes: No:
How large a pen?
Will you be chaining or putting your dog on a runner?
Yes: No:
For what length of time?

38. What do you plan to do with your pet when you go on vacation?

39. For which of the following reasons would you give up your pet?
Moving:
New baby:
Not getting along with children:
Not getting along with other pets:
Divorce:
Getting out of fence:
Behavior problems:
Children lost interest:
Financial:
Aggressive:
Got too big:
Too time consuming:
Shedding:
Allergies:
Barking:
Pet becomes sick:
None:
Other:

40. Would you object to an authorized representative of EVHS inspecting the animal and premises where the animal is being kept?
Yes: No:

41. Any questions/comments/concerns?