Employment status: Company name and phone number:
Family info? Children Ages:
- Which pet are you interested in adopting?
- Why have you chosen to adopt this particular pet? (Please include pet's name)
- Have you recently lost a pet:
- To disease? *
- Hit by a car? *
- Other? * Reason?
- What type of housing do you reside in? Condo Owner* Home Owner* Apartment*
- If you are currently renting, can you provide written permission and/or a Contract to adopt this pet?
Will you allow a Pet Samaritan volunteer to visit your home? *
Note: Site visit restrictions at this time due to COVID-19. With exception of seeing secure fenced yards for dog adoptions.
Where will your cat live? *Indoors
If adopting a cat, do you plan on declawing? *
Who will care for your pet when you are on vacation?
What type of ID will your pet have? * Microchip is included in adoption fee
Do you have a totally enclosed and secure yard? * (certain dog types/breeds will require)
Where will your dog live? *Indoors
Will you take your dog to obedience class?
How many hours will your pet be alone each day?
Do you have a dog/cat door?