City, ST, Zip
Animal of Interest
Are you at least 18 years of age? yes
Are all of the adults in the home aware that you are adopting? yes
Does anyone in the home have allergies to animals? yes
Are there children living in the home? yes
If yes, please list their ages:
Have the children been around animals before? yes
Where do you live? Farm
House w/large yard House w/small
Do you rent your current place of residence? yes
If yes, please provide your landlord's name and phone
How long have you been at this address?
Will you be moving soon?
How many animals have you had in the past 5 years? Dogs
Are they still with you? yes
If not, where are they now?
Are/were all of your pets current and up to date on all vaccinations? yes
Are/were all your pets spayed/neutered? yes
Who is your current veterinarian?
Are your pets primarily kept: Inside
How many hours per day will your pet be home alone?
How will you correct inappropriate behavior problems?
Who will provide for your pet in your absence? (vacations, emergencies,
May One of A Kind Pets contact you in the future to follow up on this
adoption? yes no
I certify the above answers to be true and accurate. I realize that
false information will result in denial of this application. I further
acknowledge that by typing my name below, it will stand as my written