PET ADOPTION APPLICATION

Pet ownership is a serious responsibility. We ask that all persons interested in adopting one of our animals, fill out this application completely, prior to adoption. This application is designed to help us determine if the adoption is in the animal’s best interest and to assist the potential adopter in finding the animal most compatible with his or her lifestyle.

Please complete the following form:

Date:

Have you ever surrendered an animal to a shelter? Yes No

If yes explain:

Interested in Adopting a Dog or Cat: (name)

Reason for wanting this pet?

How many hours a day would this pet be left alone?

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

Name:

Address:

City:

State:

Zip Code:

Phone (Home):

Phone (Office):

Email:

I reside in a:

House Apartment Mobile Home Duplex Condo

Do you own or rent?

Own Rent

How long at this address:

If rent, Property Owner's name:

If rent, Property Owner's phone number:

Number of Adults in residence:

Number of Children in residence:

Ages of Children:

Who will own & care for the pet?

Where will the pet be kept? Check all that will apply:

Inside Home Dog house Pen Shed/Barn/Garage Other

Do you have a fenced yard? Yes No

If yes, type of fence:

Name & city of your Veterinarian(s):

Vet's Phone Number:

List any cats/dogs you have owned in the last two years:

Pet's Name:

Cat or Dog?
Cat Dog

Breed:

Age:

Sex:
Male Female

Spayed/Neutered?
Yes No

Still Have?
Yes No

Pet's Name:

Cat or Dog?
Cat Dog

Breed:

Age:

Sex:
Male Female

Spayed/Neutered?
Yes No

Still Have?
Yes No

List two references including addresses:
#1

Are you familiar with the Animal Control ordinances in your area concerning:

Licensing: Yes No

Shots: Yes No

Leash Laws: Yes No

Do you agree to the following?

Yearly vaccinations: Yes No

Spaying/ Neutering: Yes No

Heartworm medications for dogs: Yes No

Would you agree to your home being inspected by a GCHS representative?

Yes No

The Shelter cannot guarantee that any adopted animal is free from heartworms: Therefore it is advisable that anyone who adopts a dog should take it to his Vet for a checkup. Any expense will be paid by the adopter.

Dog & cats will be adopted as household pets only, where they will be kept as part of the family and will not be chained. Pets may not be adopted as gifts to someone outside the immediate family.

If, for some reason, the animal is incompatible or dies within 14 days, we will replace the animal, but there will be no refund. Proof will need to be provided in case of death.

Name of Applicant:

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