NAME OF PET you are applying
Street Address, City, State, Zip:
Why do you want to adopt this pet? Check all that apply:
Companion for you
Companion for other family member
Companion for other pet
Your Veterinarian's Name & Phone Number: If
you have never had a pet before please list the vet that you will likely use.
How many people
in household? Number of adults + ages & children
Who will be the primary caretaker of this pet?
Is there anyone in the home who may be adversely affected by dogs/cats
Do all members of household want to adopt this pet?
Do you own your home? If
no, please provide landlord's name and phone number:
Type of Residence: Select one:
How long have you lived at your present location?
Do you anticipate moving in the near future?
If yes, explain.
Do you have a fenced in yard? If yes, describe?
How do you rate your pet experience?
First time pet owner
Please list the pets in household now, age, breed,
& sex: Are they vaccinated? Spayed/neutered? On heartworm
Tell us about any pets you have owned in the past 10 years: What happened to these pets?
Will the pet wear a collar and I.D tag?
Are you aware that a rescued pet may not be fully housetrained?
Are you willing and able to housetrain the pet?
If a behavioral problem appears, what steps will you take to work on
If applicable (Dogs), would you
be willing to take the pet to obedience training?
If applicable (Dogs), how do you plan to exercise the pet?
How many hours a day will this pet spend without humans?
If applicable (Dogs), if more than 8 hours, do you have someone to take
the pet out? Explain.
When will the pet be inside?
All the Time
In and Out
Where will the pet sleep at night?
Which of the following behavioral issues would
prompt you to give up your pet? Check all that apply:
Biting/Scratching Family Member
Poor Guard Dog
Not Friendly with Guests (barking, hiding)
Aggressive with Dogs/Cats
Chewing on Furniture or Carpet
Problems with Housetraining or Litter Box Training
Aggressive with Other Pets in the Household
None of the Above
Which of the following reasons
would prompt you to give up your pet? Check all that apply:
Having a Baby
New Spouse/Partner doesn't Like Pet
Pet's Health Problems
Excessive Veterinarian Bills
None of the Above
Would you agree to a home
visit by an Out of the Woods representative?
If there is any other relevant information you would like us to know:
all entries for accuracy, then press the "Submit" button.