Adoption Application

Applcation Date*

MM

DD

YYYY

Animal interested in:*

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home/Cell Phone*

Work Phone*

Email*

How many adults live at your residence?*

How many children live at your residence?*

Ages of all household members?*

Does everyone in your household agree to adding a pet?*

Yes
No

Does anyone in your household have allergies?*

Yes
No

Residence type*

How long have you lived at your current address?

Do you rent?*

Yes
No

If Yes? is all right with your landlord to have a pet?*

Yes
No

Landlord's Name*

First Last

Landlord's phone number

Do you have a fenced yard?*

Yes
No

If Yes, what type of fence and what is the height?*

How many animals do you currently have?*

What are they?*

Are your current pets either spayed or neutered?*

Yes
No

Who is your current vet? Please include phone number*

Can we call there for a reference?*

Yes
No

We require that all of your pets have current vaccinations. We also require that you cat(s) have been felv/fiv tested, that your dog(s) be on heartworm preventative. If your pets are not current on the above items they must be brought up to date prior to adpoting a pet.*

Are your current pets inside,outside or both?*

Inside
Outside
Both

What other animal have you owned?

What happened to these animals?*

Who was your vet for your previous animals?*

Have you ever had to relinquish an animal?*

Yes
No

If Yes, Why?*

Have you ever been accused or convicted of a crime against animals?*

Yes
No

If Yes,What happened?*

Describe a typical day for current and/or new pet(s), where will your pet(s) sleep, how long are you gone each day and where will your pet(s) stay while you are gone, etc:*

If you were to become incapacitated or in any way unable to care for your pet(s) what would to happen them and/or who would take care of them?*

With regards to pets, do you consider yourself*

Very experienced
Somewhat experienced
Novice Pet owner
I'm a first time pet owner

Please list a personal reference who is not a member of your household*

First Last

Phone*

I agree that if my application is approved and I adopt a pet from Tysor Veterinary Clinic, my new pet will be a family member and will primarily be an inside pet. I have considered the responsibility of taking in a new pet and to the best of my knowledge the answers to the above questions are true and correct.*

Agree
Disagree

Monday	8:00am – 5:00pm
Tuesday	8:00am – 5:00pm
Wednesday	8:00am – 5:00pm
Thursday	8:00am – 5:00pm
Friday	8:00am – 5:00pm
Saturday	8:00am – 12:00pm
Sunday	Closed

Adoption Application

Please be sure and fill out each box in the application or it will not send. Feel free to use n/a if the question does not apply to you.

Adoption Application

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