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Street Address: *
City, State, and Zip: *
How long have you lived at the above address? *
Email: *
Phone Number: *
pet.) (heartworm, will
Preferred method of contact and the best days and times to reach you: *
Occupation: *
If you rent or live with family, please provide the name and phone number of your landlord or the homeowner. (Enter N/A if you are the homeowner.) *
Does your landlord of HOA have any animal, breed, weight, or fence restrictions? (Enter N/A if you do not have a landlord or HOA.) *
How many people live in your household? *
What are the ages of any children in your household? (Enter N/A if there are no children under 18 years of age in your household.) *
Are any members of your household allergic to animals? If yes, please provide details. (Enter N/A if not applicable.) *
How many total hours will your new pet be left alone during the day? *
Where will your new pet sleep? *
If other, please specify:
If adopting a dog or puppy, what procedures will you use for housebreaking? How will you handle chewing or destructive behavior? (Enter N/A if not adopting a dog or puppy.) *
If adopting a cat or kitten, how will you handle scratching or destructive behavior? (Enter N/A if not adopting a cat or kitten.) *
If yes, where did you adopt from and where is that pet now? (Enter N/A if you have not adopted a pet before.) *
If yes, please explain the circumstances (Enter N/A if you answered No): *
Do/did your current/past pets live indoors or outdoors? (Enter N/A if you've never owned a pet.) *
If yes, please provide the product name you use for preventative (heartworm, flea/tick). If no, please explain why. (Enter N/A if you do not currently own any animals.) *
Applicant Signature: *
Date: *
