RE: __________________ (Animal Interested in Adopting) Adoption Application The following information is requested so that your Adoption Counselor can assist you in the selection of a new pet. The consultation process is designed to help us assist you in finding an animal most compatible with your lifestyle and to determine if the adoption is in the best interest of the animal. In order to be considered as an adopter, you must be: ٭ ٭
18 years of age or older and have identification showing your current address. Be willing and able to spend the time and money necessary to provide training, medical treatment, and proper care for a pet for its natural lifetime.
Today’s Date: ______________ Have you previously applied to or adopted from BARC? No Yes Name: _______________________________________________________ Home Phone: ________________________________Cell Phone: ___________________________ Email Address: __________________________________________________________
RESIDENCE INFORMATION Address: ________________________________________________________________________ City/State: __________________________________________________ Zip: __________________ Number of adults: _______ Number of Children: _______ Ages of Children: ____________________ Do all adults agree to this adoption? ___________ Do you: Own Rent House Condo Apartment Mobile Home Townhome Name of Apartment Complex: _________________________________________________________ Landlord's name / phone: ___________________________________________________________ If you do not own, do you have your Landlord's permission to have a pet? No Yes Is a deposit required? No Yes Amount? ___________ Has it been paid? No Yes Are there any breed, size, or number restrictions where you live? ____________________________
ANIMAL CARE INFORMATION Are you interested in adopting a Cat Dog Please circle any of the following reasons for adopting a pet: Watchdog Companion
Barn Cat Mouser Hunting Family Pet Guard Dog for Business Home Companion for other pet Gift (is it a surprise? Yes No ) Other (please specify):_____________________ What size animals are looking for? Extra Small (less than 15 pounds) Small (1625 pounds) • Medium (2645 pounds) Large (4660 pounds) Extra Large (61+ pounds)
Where will this pet be kept during the day? ____________________ At night? ___________________ How many hours per day will this pet be left with no one home? _____________________________ If this pet were lost, what would you do? _______________________________________________
CAT OR KITTEN ADOPTION INFORMATION (If you are adopting a cat/kitten, please complete this section). Have you ever owned a cat or kitten? No Yes Are you aware that cats/kittens often jump on furniture and tables? No Yes It is a natural instinct for cats to sharpen their claws (i.e.: scratch carpet/furniture). What methods would you use to deter such behavior? ________________________________________________ Do you intend to let your cat go outside? No Yes Do you intend to physically alter your cat (i.e. declaw)? __________________________________
DOG OR PUPPY ADOPTION INFORMATION (If you are adopting a dog/puppy, please complete this section). What do you consider valid reasons for giving up a dog: (Mark all that apply) Moving Fleas Destructive Biting Grew too big Digging Chewing Unable to Housetrain Too rough with children barking (too much / too little) Having a baby Shedding OtherExplain: ___________________________________________________________________ How will you keep this dog confined? (Mark all that apply) House Kennel Fence Chain Garage Patio Leash Crate Other: ________________________ If crated or kenneled, how many hours per day? __________________________________________ Will the dog have access to a yard? No Yes Is your yard: Partially fenced Completely fenced Open If fenced: Type? _____________ Height? _________ Condition? _________ You will have to housetrain a new puppy or dog. Are you willing to work with the dog and achieve success with positive reinforcement? _____________________________________________ Where and how will you exercise this dog? _______________________________________________ Are you familiar with Heartworms? Yes No With flea and tick preventative? Yes No
List all pets you currently have in your household:
Please provide the name of your veterinarian: ______________________________________ Phone: _____________________________Address:__________________________________ What type of heartworm prevention do you currently use? ___________________________________ What type of flea prevention do you currently use? _________________________________________
If you have no pets at this time, but have owned pets in the past years, what happened to them?
____________________________________________________________________________ _____ Dogs often live 10+ years. Are you prepared to make this commitment? Yes No Cats often live 15+ years. Are you prepared to make this commitment? Yes No I certify that the above information is true and correct. I understand that false information may result in nullifying this adoption. BARC reserves the right to deny an adoption to anyone.
Please PRINT YOUR NAME: _______________________________________________________ Signature of Applicant: ______________________________________ Date: ___________________
FOR BARC USE ONLY: Approved Denied Adoption Counselor: ______________________
Declined, why? ________________________
Published on Oct 12, 2011