How Many children in family?
Full name:
Home Phone:
Work Phone:
Street:
City:
State:
Zip:
Email Address:
Occupation:
Drivers License:
I wish to adopt a
Breed:
My residence is a
How Long Have You Lived There?
Do you
If renter, do you have your landlord's permission to have a animal?
If you move, what will you do with the pet?
What if the new landlord doesn't allow pets?
Ages of children:
Landlords Name:
Landlords Phone:
How many hours will the animal be alone during the day?
Where will the pet be left when kept alone?
Do you own any pets now?
What kind?
How Old?
Neutered / Spayed
If you have previously owned pets, but no longer have them, what happened to them?
If adopting a dog, do you want a
Where will the dog be kept?
(Select all that apply by holding Ctrl Key)
If in fenced yard, FENCE HEIGHT:
Does your town have a leash law?
Are you willing to leash walk your dog?
If adopting a cat, is it for
(Select all that apply by holding Ctrl key)
Do you intend to declaw?
Are any members of your family allergic to animals?
If adopting a cat, are any cats at home Leukemia or AIDS positive?
If adopting a dog, have you had any dog in your house with Distemper in the past 6 months?
Do you use rat poison in your home?
Do you use toxic chemicals in your garden or have Chem Lawn type service?
Are you willing to be responsible for this pet for it's ENTIRE LIFE, which may be 15-20 years? If you adopt a pet from us you will be required to sign a legal adoption contract promising that you will provide necessary inoculations for your new pet within 5 days, and, (if young), that you will neuter/spay it within a specified period.
Are you willing and able to afford these terms?
Veterinarian's Name:
Please give any additional information about yourself that may help us with our decision.
Bosler Humane Society
Pet Adoption Application
Electronic Submission Form
