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Name of Animal You Are Applying to Adopt: |
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Your Email Address: |
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Name of 1st Applicant: |
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Name of Co-Applicant: (if applicable): |
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Age of 1st Applicant:: |
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Age of Co-Applicant:: |
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Daytime Phone Number: |
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Evening Phone Number: |
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Address: |
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Please indicate what type of home you live in?: |
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Do you own or rent your home?: |
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Landlord Name & Phone (if rent): |
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How long have you lived at your current address?: |
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How many times have you moved in the last 5 years?: |
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If you moved where pets where not permitted, what would you do with them?: |
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Do you travel? If so, who takes care of your pets?: |
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Do you have a fenced yard? How high is the fence?: |
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Do you have existing pets, if so please tell us about them: |
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Why would you like to adopt an animal? Please explain your primary reason: |
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How many adults are in the household?: |
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Please list the ages of any children in the house and whether they have experience with pets: |
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Is your current pet(s) spayed/neutered? If no, why not?: |
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Is your current pet(s) current on vaccinations? If not, why not?: |
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If adopting a cat, will it be an inside or outside cat?: |
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Where will the animal sleep at night?: |
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Where will the animal spend its days?: |
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Do any of your current pets spend time outside? Tell us about that.: |
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Where will you put a cat litter box?: |
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What will you do if the cat stops using the litter box?: |
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Do you plan to declaw a cat?: |
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Have you ever had a pet with behavioral problems?: |
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How have you handled behavioral problems?: |
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Under which circumstances would you give up a pet?: |
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Please tell us the name, address and phone number of your vet: |
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How much do you believe the annual expenses for this animal will be?: |
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Who will be the primary caregiver of the pet?: |
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Do you have any health issues that would affect your ability to care for the pet?: |
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What major lifestyle changes do you anticipate in the next 15 years?: |
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Have you ever given up a pet? If so, please tell us why and what you did with it.: |
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Has any animal on your premises died of distemper, parvo, FIV or leukemia in the last 3 months?: |
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Have you adopted from NBAR before? If so, do you still have the animal? If not, where is it?: |
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Are you willing to allow our representative to visit your home by appointment?: |
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Personal Reference #1 Name, Phone & Relationship to you: |
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Personal Reference #2 Name, Phone & Relationship to you: |
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Do you have the time to provide adequate love and attention to a pet?: |
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How do you discipline a pet?: |
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Do you agree to provide healthcare do your pet if it gets sick?
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Do you agree to keep a dog on heartworm and flea prevention?: |
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Has anyone in your household ever been accused or convicted of animal abuse, cruelty or neglect?: |
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Do you agree you will provide adequate food, water, and annual vaccinations for this pet?: |
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Do you agree that all the information you have given is true and accurate?: |
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Signature: |
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Date: |
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