Full Name:  * Spouse: Phone Number:  * Email Address:  * Street Address:  * City:  * State:  * Zip Code:  * Occupation:  * Spouse Occupation What pet are you wanting to adopt?  * How did you hear of us? Why do you want to adopt a pet? People in household: # of Adults:  * Age of adults:  * # of children:  * Ages of children:  * Are all members in the home in agreement with adopting this pet? yesno half and half Does anyone in the household have any allergies to pet hair/dander (select one)? YesNo Will a growing family change your ability to home and care for your pet? YesMaybeNo plans to grow our family Living quarters (select one)? Own homeOwn condoRent homeRent condoRent apartmentNone of the above Are pets allowed (select one)? YESNO Any restrictions? YESNO If rent - landlord approval? YES NO Is a yard available? YESNO Yard Available: What size is the yard?  * Is it fenced in? YESNO If you have a fence - how high is it? If NO fence is available - how will you contain your pet outdoors? Do you live in a high traffic area? YESNO If you move and pets are not allowed - what will you do with your pet?  * Hours a day pet will be left alone?  * Where will the dog/puppy stay when left alone?  * Where will the pet sleep?  * Do you plan to take your dog/puppy to obedience training? YESNO If adopting a cat - would you allow your cat to go outdoors? YESNON/A If you experience behavioral problems with your pet what will you do?  * Is this your first pet? YESNO If you have/had other pets- provide the type of pet? male or female? spayed or neutered? current on vaccines? Age and current locations? Veterinarian or Clinic where current pet was vaccinated  * Phone # of Veterinarian Clinic where pet was vaccinated  * May we call them? YESNO Tell us about current and prior pets Have you ever had to surrender a pet? yesno If yes please explain Will you provide annual OR AS NEEDED medical treatment and check-ups for your pet? YESNO Are you prepared to start your new pet on heartworm prevention at the time of adoption? YESNO Are you aware that additional vaccinations are necessary for your pet besides what is covered by the adoption fee? YESNO Will your new pet be seen by a vet? YESNO If YES When? Please list 2 references who are not related to you: Name1 - Phone  * Name2 - Phone  * Will you contact RC Humane with any problems or concerns...or circumstance that may lead you to surrender your adopted pet? YESNO What challenges and/or satisfaction will this pet bring to you and your family? Additional comments to assist us in the adoption process: Are you willing to accept a 24-48 hour waiting period (if needed) for application approval? YESNO what size dog are you looking for Do not enter anything in this field: