Clifton Animal Shelter Pet Adoption Application

Welcome to the Friends of the Clifton Animal Shelter.

The following information is required so that we may assist you in the selection of a new pet.

By signing and submitting this application, you certify that FOS has your permission to contact your veterinarian regarding your pets.

E-mail Address: *

Name:

Address:

City:

State:

Zip:

Tel No: Home:

Work:

Cell:

Date of Birth: *

What kind of pet are you here to adopt? * Puppy Dog Cat Kitten

What are your reasons for adopting? *

If the pet is to be a gift, give the name of the person with whom the pet will reside:

Do you have any preference as to breed type, age, sex, size, etc? Yes No

If yes, explain:

Have you ever had a pet before? Yes No

If so, what kind? Cat Dog Other

For how long?

How long ago?

Were your pets: Indoor pets Outdoor pets Both

Was your pet spayed/neutered? Yes No

If that animal is no longer in your household, what happened?

Do you have pets in your household now? Yes No

If so, how many?

What kind?

What are their names?

Are they licensed? Yes No

Are they kept : Inside Outside Both

If you have cats, were your cats tested for FeLv (feline leukemia) and FIV? Yes Yes

Are you: Single Married Other

Spouse name:

Are there any children in your household? Yes No

If so, how many?

What are their ages?

How many adults in your household?

Do all adults know that you plan to adopt? Yes No

Are there any senior citizens or physically/mentally disabled persons in your household? Yes No

Do you live in a: House Apartment Other

How long have you resided at your present address?

Do you: Own Rent

Landlord name and phone if you rent

Does anyone in your household have any known allergies to animals? Yes No

Is anyone home during the day? Yes No

If no, how long will the pet be left alone in a 24 hour period?

Where will your pet spend the majority of its time?

Are you financially prepared to give your new pet routine and emergency medical care such as rabies vaccinations, inoculations, exams, etc? Yes No

Have you ever adopted from us before? Yes No

Have you ever turned in an animal to us before? Yes No

In the event of unforeseen accident, illness or extended absence, who would care for your animal if, for reasons beyond your control, you could not?

Will this dog be used for a: Family pet Guard dog Breeder Companion for another pet

Do you have a fenced in yard? Yes No

If yes, how high is the fence?

Does the fence drop in height at any points? Yes No

Do you have a: Back yard Front yard

Are the 2 yards separate from each other? Yes No

What kind of fence is it? (ex.: chain link, wood, etc.)

Are there holes in the fence? Yes No

Can an animal dig under the fence? Yes No

Are you familiar with crate training? Yes No

Are you familiar with leash and licensing laws in your community and will you have your new pet licensed immediately? Yes No

Do you realize that you will probably have to housetrain your new dog? Yes No

What will you do if your dog chews furniture or shows other signs of destructive behavior?

How will your dog be confined to your property? On Leash Fenced Yard Chain Garage Kennel In home

Do you want the cat for a: House pet Mouser Breeder Companion for another animal Gift Other

Will the cat be allowed outdoors? No Yes

What will you do if your cat claws your furniture or shows other signs of destructive behavior?

Who is your veterinarian?

Phone #

Whose name are the vet records in?

If the previous pet was more than three years ago, what was the pet’s name?

Will you spay or neuter your pet within 30 days? Yes No

How did you hear about us?

Would you object to a visit from an FOS representative to see how you and your new pet are doing? Yes No

Date:

Signature:

Verification Code:

Enter Verification Code: *

* Required

Thank you for taking the time to complete this questionnaire. Your answers will enable us to “match” a cat or dog to you and your household. Good luck!

NOTICE: You must complete all information to be considered as an adopter. By signing below, you certify that you understand the following terms:

A. The FOS reserves the right to refuse adoption to anyone.
B. The information above is accurate and not misleading in any way.
C. The FOS reserves the right to contact the individual(s) listed on this form.
D. Completion of this application DOES NOT guarantee adoption.
E. You are responsible for checking back on the status of your application or the availability of the type of pet you are seeking.

By signing and submitting this application you certify that FOS has your permission to contact your veterinarian regarding your pets.