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ADOPTION APPLICATION
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2025-03-05T13:27:12-06:00
ADOPTION APPLICATION
Applicant Information
Name
(Required)
First
Last
Phone
(Required)
Email
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
Address
Street Address
Address Line 2
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
Employer Information
Name
(Required)
First
Last
Phone
(Required)
Email
(Required)
Address
Street Address
Address Line 2
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
MEMBERS OF HOUSEHOLD
Name
First
Last
Age
Relationship
Is everyone in the household agreeable to adopting a pet?
Yes
No
If you have children what are their experiences around animals?
REFERENCES
(NOT LIVING WITH YOU)
Name (Reference #1)
(Required)
First
Last
Phone
(Required)
Relationship
(Required)
Name (Reference #2)
(Required)
First
Last
Phone
(Required)
Relationship
(Required)
Housing Information
DO YOU LIVE IN A HOUSE OR APT OR OTHER (PLEASE EXPLAIN)
(Required)
DO YOU RENT OR OWN, IF YOU RENT DO YOU HAVE PERMISSION TO HAVE PETS
(Required)
LANDLORD INFORMATION
Name
First
Last
Phone
YARD
DO YOU HAVE A FENCED YARD, IF SO WHAT KIND OF FENCE (CHAIN LINK, WOOD, ETC & HOW TALL IS FENCE)
(Required)
ANIMAL INTERESTED IN NAME:
WHY DO YOU WANT TO ADOPT
(Required)
WHAT ARE THE CRITICAL CHARACTERISTICS YOU WANT IN THE ANIMAL
(Required)
WHAT BEHAVIORS/HABITS WILL YOU NOT TOLERATE
(Required)
ARE THERE BREEDS YOU WILL NOT ADOPT
(Required)
WHAT AGE RANGE ARE YOU LOOKING FOR (WE CAN'T GUARANTEE BUT WE DO HAVE APPROXIMATIONS)
(Required)
WILL YOU KEEP THE ANIMAL AS INSIDE OR OUTSIDE OR COMBINATION OF BOTH
(Required)
WHAT IS THE ACTIVITY LEVEL IN YOUR HOUSEHOLD
(Required)
WHERE WILL THE ANIMAL BE KEPT WHEN YOU ARE NOT AT HOME
(Required)
WHERE WILL THE ANIMAL SLEEP AT NIGHT
(Required)
HAVE YOU EVER SURRENDERED AN ANIMAL, IF SO PLEASE EXPLAIN
(Required)
ARE THERE CIRCUMSTANCES THAT YOU WOULD SURRENDER AN ANIMAL,PLEASE EXPLAIN
(Required)
DO YOU HAVE A LONG TERM PLAN FOR YOU ANIMAL SHOULD YOU PASS AWAY OR BECOME DISABLED OR UNABLE TO CARE FOR THEM
(Required)
WE REQUIRE PROOF OF SPAY/NEUTER FOR ALL ANIMALS, IF THEY ARE NOT SPAYED OR NEUTERED WHEN THEY LEAVE OUR CARE YOU MUST PROVIDE PROOF THIS WAS DONE WITHIN 45 DAYS. EXCEPTION ARE PUPPIES THAT ARE NOT OLD ENOUGH IN THIS CASE ONCE THEY ARE OLD ENOUGH 6-9 MONTHS OF AGE YOU MUST PROVIDE PROOF. BY SIGNING YOU ARE AGREEING TO DO THIS & TO PROVIDE INFORMATION TO APA
TRAINING
HOW DO YOU PLAN TO TRAIN YOUR NEW ANIMAL
(Required)
CURRENT PETS LIVING IN YOUR HOME NOW, IF NOT APPLICABLE ENTER "NONE"
Name
First
Last
Age
Breed
Sex
HOW LONG DID YOU HAVE THEM
UP TO DATE ON INOCULATIONS (SHOTS, HEARTWORMS, FLEA/TICK)
(Required)
YES
NO
DATE of INOCULATIONS
(Required)
MM slash DD slash YYYY
ARE THEY SPAYED & OR NEUTERED?
(Required)
YES
NO
DO THESE ANIMALS GET ALONG WITH OTHER ANIMALS?
(Required)
YES
NO
WILL YOU KEEP THE ANIMAL AS AN INSIDE PET, OUTSIDE PET OR COMBINATION OF BOTH? PLEASE EXPLAIN.
(Required)
IF NOT PLEASE PROVIDE THE BEHAVIORS AND TENDENCIES THAT OCCUR
(Required)
IF NO, PLEASE EXPLAIN
(Required)
VETERINARY INFORMATION
Who is your Veterinarian: Name
(Required)
First
Last
Phone
(Required)
NAME THE RECORDS ARE IN
(Required)
First
Last
PAST PETS , IF NOT APPLICABLE ENTER "NONE"
Past Pet's Name
First
Last
AGE
SEX
BREED
HOW LONG DID YOU HAVE THEM?
WHAT HAPPENED TO THEM?
WERE THEY UP TO DATE ON INOCULATIONS (SHOTS, HEARTWORMS, FLEA/TICK)
Yes
No
WERE THEY SPAYED & OR NEUTERED, IF NOT PLEASE EXPLAIN WHY
Yes
No
Reson Why Not Spayed or Neutered
ANYTHING ELSE YOU WOULD LIKE TO TELL US ABOUT YOURSELF OR CIRCUMSTANCES
Check this box if,
I UNDERSTAND THAT APA CAN DECLINE AN APPLICATION FOR ADOPTION FOR ANY REASON
Check this box if,
I ATTEST THAT THE INFORMATION PROVIDED ON THIS APPLICATION IS TRUE AND ACCURATE & UNDERSTAND THAT COMPLETING THIS APPLICATION DOES NOT GUARANTEE ADOPTION OF AN ANIMAL
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