Pet ApplicationStep 1 of 616%I am Interested in:*Dog or CatDogCatToday's Date:* Date Of Birth* MM DD YYYYMust be 21 years of age or older to adoptApplicant information:Name* First Name Last Name Address* Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email address:* Primary Phone Number:*Alternate Phone:Best way to contact you:EmailPrimary PhoneAlternate Phone About Your Home:What type of home do you live in?*Single FamilyApartmentCondoMobile HomeFarmOtherDo you have a fenced in yard?*YesNoType of fence:*WoodAluminum/SteelSplit RailChain LinkNoneElectricConcreteOtherHeight of fence?*Do you own or rent?*OwnRent If you rent, please answer the following 4 questions. If you do not provide the information, we will NOT process your application Does your rental agreement allow for pets? Is there a weight limit?How much is your pet deposit?Landlord Name:Landlord Phone Number:About your family:How many adults live in your home?*Do you have any children living in your home?*YesNoIf yes, how many and what are their ages?*Is anyone living in the home allergic to animals?* About your current pets:Please list all pets you currently own.1) Please include name, type and age:*2) Please include name, type and age:3) Please include name, type and age:4) Please include name, type and age:Please provide any additional information on your current pets you feel we should know:*About your past pets:Please list pets you have owned in the past 5 years.1) Please include name, type, age and how long owned:*2) Please include name, type, age and how long owned:Please provide any additional information on your past pets you feel we should know:*What happend to the pets you no longer own?*Your Veterinarian:Please provide information veterinary clinics who have provided medical care for your pets past and present. Out of State veterinarians are ok. If you do not currently have pets please put which vet you plan to use.Name of Veterinarian or Clinic:*Veterinarian phone number:*Some Veterinarians require that the owner calls to release information.Will you call to give permission to release information about your pets?*What owner name are the pets listed under?*Your Veterinarian*Currently UsingWill UseHave Used BeforeNever Used Before Pet Preferences and Care:Why do you want to own a new pet?*Do you understand that owning a pet can be a commitment of 10 to 15 years?*Which pet are you interested in?*Where will your new pet live?*Where will your new pet live when it grows up?*How much time will your new pet spend alone?*Where will your new pet stay when alone?*Where will your new pet sleep?*Do you consider pets part of the family?*Will you have your new pet spayed/neutered?*Will you take your new pet to obedience classes?*How will you control fleas and heartworms?*If adopting a cat or kitten are you planning to declaw?*What circumstances would cause you to give up your pet?*Are you financially prepared to give your new pet routine medical care? (food, Yearly check-ups and shots, monthly flea and heartworm preventative)*Is there any additional information you would like to provide?* Personal References:Reference #1 Name:*Phone*E-Mail: Relationship to Applicant:*Reference #2 Name:*Phone*E-Mail: Relationship to Applicant:* This iframe contains the logic required to handle Ajax powered Gravity Forms.