PET ADOPTION APPLICATION Please print all information. If we can’t read it, we can’t process it. Thank you. By completing this form, you will assist us in establishing that you and your family are ready for the responsibilities of pet ownership. If you qualify and are accepted, we will contact you. NAME: ________________________________________ WHERE EMPLOYED: _________________ HOME ADDRESS: _______________________________ HOW LONG EMPLOYED: _____________ _______________________________ WORK PHONE: ______________________ CITY:_______________STATE:________ ZIP: ________ HOW LONG AT ADDRESS: ____________ HOME PHONE: ________________________________________ CELL PHONE: _________________ EMAIL ADDRESS: ____________________________________________________________________ NAME OF PET(S) YOU ARE INTERESTED IN ADOPTING: _________________________________ 1. Why do you want to adopt a pet at this time? _____________________________________________________ __________________________________________________________________________________________ 2. What preparations have you made (or will make) for your new pet? ___________________________________ __________________________________________________________________________________________ 3. Do you want this dog as a [ ]watchdog [ ]companion/family member [ ]child’s pet [ ]hunting dog [ ]guard dog [ ]fighting dog [ ]outside dog [ ]company for other pet [ ]gift [ ]other ___________________________ 4. Who will have primary responsibility for your new pet? ____________________________________________ 5. Have all adults in the household been consulted and do they agree to this adoption? [ ]Yes [ ]No 6. Are you financially able to take care of an ill or injured pet (which may cost hundred of dollars)? [ ]Yes [ ]No 7. Please describe the extent of care that you are willing to provide should your dog have special needs now or in the future: _________________________________________________________________________________ 8. Do you live in a [ ]house, [ ]apartment, [ ]townhouse, [ ]condo, [ ]other: ____________________________ 9. If renting, do you have permission to keep pets? [ ] Yes [ ]No Landlord’s name: ________________________ Phone number: ___________________________ 10. If a pet deposit is required, has it been paid? [ ]Yes [ ]No 11. Will the adoption of this pet comply with your subdivision/condo/apartment regulations? [ ]Yes [ ]No 12. Do you have a yard? [ ]Yes [ ]No If yes, please describe [ ]no fencing, [ ] partially fenced, [ ] completely fenced. If fenced, type of fencing? _______________ Height of fencing? ____________ (NOTE: A picture may be required of your yard.) 13. Have you ever owned a pet? [ ]Yes [ ]No If yes, please list your current pets below: PET NAME AGE PET TYPE BREED SIZE __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ __________________________________________________________________________________________________________ If there are additional pets, please [ ] check here and list them on the back of this form. 14. Have you ever had to give up an animal for any reason? [ ] Yes [ ] No If yes, what happened to the pet? Did you [ ] take the pet to a shelter, [ ] found the animal a new home, or [ ] other? If other, what did you do? ___________________________________________________________ 15. During the last two years, have you: [ ] lost a pet (runaway pet), [ ] had one poisoned, [ ] was killed by a vehicle, or ( died from disease? If so, what disease did the animals die from? __________________________ 16. Are all pets in the household current on their vaccinations? [ ] Yes [ ] No (NOTE: For cats, feline distemper, leukemia, rabies. For dogs, canine distemper, hepatitis, parvovirus, rabies.) 17. Are all pets spayed or neutered? [ ] Yes [ ] No 18. Are you using heartworm preventative? [ ]Yes [ ] No If yes, what kind?______________________________ 19. Please describe your personal knowledge of the causes and prevention of heartworms: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 20. Please provide your Veterinarian’s name:________________________________________________________ Phone: ____________________Address:________________________________________________________ 21. Do you have any children? [ ] Yes [ ] No If yes, what are their ages? _________________________________ 22. Have you taught your children how to treat animals with respect and kindness? [ ] Yes [ ] No 23. Are there any members in your family who have any known pet allergies? [ ] Yes [ ] No 24. Do you plan to take this pet to formal training classes? [ ] Yes [ ] No If yes, what kind? __________________ Where will the training take place?____________________ If no, how will you home train your new pet?______________________________________________________________________________________ 25. Where will you exercise this pet? _______________________________ How often? _____________________ 26. How will you transport this pet? _______________________________________________________________ 27. If crated or kenneled, how many hours per day? _____________________ How big is the crate or kennel? _________________________________________________________________________________________ 28. You may need to house train a new puppy or dog. What is your method of house training? __________________________________________________________________________________________ 29. Can you invest the time and effort to allow this pet to adjust to its new home? [ ] Yes [ ] No How long seems reasonable for this? _________________________________________________________________________ 30. What do you consider valid reasons for giving up a pet? (Mark all that apply.) [ ] moving, [ ]fleas, [ ] destructive, [ ] biting, [ ] grew too large, [ ] chewing, [ ] unable to house train, [ ] too rough with children, [ ] vet bills, [ ] barking too much, [ ] too active, [ ] digging, [ ] having a baby, [ ] other _________________________________________________________________________________________ 31. What will you do if the pet demonstrates the following behaviors? Digging ____________________________ Chewing __________________________________ Not getting along with other pets ____________________ Difficulty adjusting to household ________________________________ How long would you give this pet to change its behavior with additional training? ____________________________________________________ 32. If needed, how would you discipline your pet? _____________________________________________________________________________________________________________________________________________________________________ 33. How many hours will this pet be left alone? ______________________________________________________ 34. Where will this pet be kept when left alone? [ ] Outside, [ ] crated, [ ] free roam of house, [ ] enclosed kitchen or laundry room, [ ]garage, [ ]other. If other, please explain: _______________________________________ 35. How many hours per day would this pet spend indoors? _______________ Outdoors? ____________________ 36. Where will the pet sleep at night? ______________________________________________________________ 37. Where will this pet be kept when you go on vacation? ______________________________________________ 38. If this pet were lost, what would you do? ________________________________________________________ 39. Do you realize that dogs and cats can live as long as 15 years? [ ] Yes [ ] No Are you willing to accept responsibility for a living creature for that long?[ ] Yes [ ] No 40. Would you object to a home visit by NABS?[ ] Yes [ ] No No animal will be adopted to prospective owners who mislead or fail to provide accurate information on the adoption application and/or the adoption contract. N.A.B.S. does not adopt pets on a first come, first served basis. All applications will be screened by N.A.B.S. to determine the most suitable match for both you and the animal. N.A.B.S. reserves the right to refuse to adopt to anyone. I certify that the above information is true and that false information may result in nullifying this adoption. Signature: ___________________________________________________ Date: ____________________ Form 1 of 3, Page 2 of 2 Revised 02/22/07, Revision 2.1 County Road 210 at Austin Bayou P. O. Box 307 Liverpool, Texas 77577 (281) 330-5238 Fax1-(610) 300-5238 Nabstx2004@aol.com www.nabs-tx.com