Application for other small animals

 

Name of Animal Interested In:__________________________                                                Date:_____________

PASF Adopter Profile (application for non dog or non cat small animals)

Name______________________________________  Spouse’s Name_________________________________

Address__________________________________________  P.O. Box_________            City____________________

ZIP_____________  Home Phone  (_____)______-_____________  Work Phone(_____)_______-__________

Are you over 18?      Yes                  No                                    Driver’s License #___________________________

 

Housing:             House             Apartment                    Condominium                       Mobile Home                         Military

Do you:             Own                         Rent                                Live with Parents

Landlord’s Name and Phone Number:___________________________________________________________

How long have you lived at this address?____________             Months             Years

Number of people in the household:___________  Adults            _____________Children (ages________________)

Does anyone in the family have allergies?_________  To:___________________________________________

Hopes and Expectations for the Pet

Type of Pet Desired?                Rabbit             Guinea Pig                Hamster               Rat/Mouse                   Bird             Other_______

Experience with this type of pet:             First-time owner             Have had a few       Knowledgeable/experienced

Reasons for wanting this animal:             Personal pet                         Friend for child             Company for other pet

 Breeding               Raise for food             Classroom pet             Gift for_______________                 Other_________

Where will the pet be kept?             Outside             Garage             Inside             Cage (size:__________________)

How much time each day will the animal be held/played with?_______________________________________

Who will be primarily responsible for the care of this animal?________________________________________

Name of your veterinarian____________________________________________________________________

Does this veterinarian treat the type of small animal you are interested in?______________________________

What would you do with the animal if you could no longer keep it?____________________________________

Are you familiar with this animal’s needs for:

Food/Supplements________                         Vet/Health Care________                     Socialization/Exercise________

Do you (and any children in the family) know how to:

Pick up/carry this animal?_______              Clip nails?_________            Introduce to other animals?________

How much do you expect this pet to cost annually?__________      What is its expected lifespan?____________

 

Other Pets Currently in the Household:

Type

Age

Sex

Altered?

Kept Where?

Time Owned?

____M  ____F ____in   ____out   ____both
____M  ____F ____in   ____out   ____both
____M  ____F ____in   ____out   ____both
____M  ____F ____in   ____out   ____both
____M  ____F ____in   ____out   ____both

 

Pet History (please list all pets owned in the last 5 years):

Type

Sex

Altered?

Kept Where?

Time Owned?

What happened?

____M  ____F ____in   ____out   ____both
____M  ____F ____in   ____out   ____both
____M  ____F ____in   ____out   ____both
____M  ____F ____in   ____out   ____both
____M  ____F ____in   ____out   ____both

 

Have you ever brought an animal to a shelter?             Yes                         No

If yes, what were the circumstances?____________________________________________________________

 

What would you do with this animal if you could no longer keep it?___________________________________

 

I AGREE THAT THE ABOVE INFORMATION IS TRUE TO THE BEST OF MY KNOWLEDGE

 

_______________________________________________                                    ________________________

Adopter’s Signature                                                                                   Date

 

For Staff Use Only

Application reviewed by:_______________________            Applicant approved for:______________________

Comments:_________________________________________________________________________________

_________________________________________________________________________________________

 

Landlord Approval Needed?_________            Date Received_____________

 

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