PetPromise Adoption Application

* which pet would you like to adopt and why?

what type of pet would you like to adopt?

DogCat

* Your Name

* Address

* City

* State

* ZIP Code

* Phone Number

* Email Address

* Homeowners/renters insurance company

* Age of Applicant

* Employment/Occupation of Applicant

Number of persons in your household

OneTwoMore than Two

Children?

YesNo

If Yes, what are their ages?

YOUR HOME

What are your living arrangements?

Own a house or detatched condominium unit

Own a condominium unit in a multi-unit building

Rent an apartment/condominium unit in a multi-unit building

Rent a house or detatched condominium unit

Live with parents

Live in college dormitory

Does your lease or homeowner's association restrict pet ownership?

YesNoDon't Know

Is your yard fenced?

YesNo

REFERENCES

Please provide the names and telephone numbers of THREE REFERENCES, including your veterinarian and, if applicable, your landlord or property manager. Other references could include a friend, neighbor, employer, relative, etc.

After submitting this application, please contact your veterinarian to let them know that they may release your pet's medical history to a PetPromise Adoption Counselor.

Due to the high volume of applications received, those without complete reference infation as outlined above WILL NOT receive a response.

Veterinarian

* Veterinarian for current and/or fer pets (if none, enter "n/a")

* Veterinarian phone number (if no vet reference, enter "n/a")

Landlord/Property manager

* Landlord, property manager, or homeowners' association name (if none, enter \"n/a\")

* Landlord, PM, or HA phone number (if no vet reference, enter "n/a")

Personal reference #1

* Personal reference name

* Relationship to applicant

* Reference phone 1

Personal reference #2

* Personal reference name

* Relationship to applicant

* Personal reference phone number

CARE & RESPONSIBILITY

Are you prepared to make a commitment to care for this pet for the next 10-15 (in the case of a dog) or 18-20 years (in the case of a cat)?

YesNoDon't Know

Are you prepared to commit to find a home where you can keep this pet if/when you move during the next 10-20 years?

YesNoDon't Know

Are you financially prepared to deal with the cost of both routine (vaccinations, annual examinations, dental cleanings, heartworm treatment, etc.) and non-routine/emergency veterinary care of this pet?

YesNoDon't Know

* How much do you expect to spend annually to care for your pet?

Approximately how many hours a day will your new pet be alone? Where will the dog/cat spend the day?

* Where will your new pet sleep?

* Who will have primary responsibility for the care of the pet?

If you are inquiring about a cat, do you intend to have him/her declawed?

YesNo

HISTORY OF PET OWNERSHIP

* What animals currently live in your household? (Please list type of animal, sex, age and how long you have owned them)

* Are these pets housed inside or outside? (please explain)

* What pets have you had in the past? (Please list type of animal, how long owned and what happened to the pet)

* How did you hear about PetPromise?

All of the information that I have provided above is true and complete to the best of my knowledge. Should a dog or cat be placed with me, it will reside in my home as a pet. I agree to provide the dog or cat with adequate food, water, shelter, affection, and medical care.

* Signature of Applicant

* Date of Application

How would you like us to contact you?

E-MailCall during the dayCall during the eveningText Message