Pet Adoption Application

Below is the Pet Adoption Application.  
It was adapted from an application taken from a Humane Societies website.
Please copy/paste then fill it in to the best of your ability.  Email it to shroomshack@gmail.com
Thanks!
~Wendy

The below version may not be clear to see on your screen.  If you are having trouble viewing or printing it out please let us know.
Thanks!

Wendy’s Shi-Anne Shih Tzus
Pets & People Profile

Date _________



Thank you for filling out this profile. The information you provide will help us help you find the best match for you and your family.

Name _______________________     Street address __________________   P.O. Box_________  City_______________ State ___   Zip ______   Home Phone ______________  Work Phone ____________ Names of others in household (include ages of children) We do NOT discriminate based on household size or number of pets you may have. :) This only helps us out during the interviewing process in helping make the best match for your family. ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________ ____________________________________________________________________________________________________________________   Name of Veterinarian:_______________________________  Clinic/city: _____________________________________ Phone Number of Veterinarian:  _________________________________ smoking or non-smoking home? _________________________________ Length of time at address _______                       Own ___    Rent __   Live with parents  __  Military__ Housing type:      __ House     __ Condo      __ Apartment      __ Mobile home Landlord name _____________________ Landlord phone _________________ How did you hear about us?  Friend/family  ________  face book________  email _______  Web site (http://shi-anneshih-tzus.blogspot.com/) _____________ Other _______________ Please visit this website:  http://www.theurbancarnivore.com/    You will find wonderful information there on caring for your new pet.  Thank You to my Long time friend, Kathy, that co-owns The Urban Carnivore in Bloomington, IL.




Current Pets

You & Your Household

Your Ideal Dog




Type ________________ Name _______________ Age ________ Sex _____ Spayed/Neutered  Yes  No Kept  Inside  Outside  Both How long have you owned this pet? _____________________	1. Dog Experience  First Time Owner  Have had one or two  Knowledgeable & Experienced	Breed Type/Mix _____________ Adult Size  0-20 lbs. Small  20-50 lbs. Medium  50-100 lbs. Large  Over 100 lbs. Giant Coat  Shortr Medium  Long r No Preference Age  8-16 weeks  4-12 months  1-3 years  Older r No preference Training  None  Housebroken  Some obedience training  Fully trained Activity Level  Low r MediumrHigh Sex  Maler Female  No preference
Type ________________ Name _______________ Age ________ Sex _____ Spayed/Neutered  Yes  No Kept  Insider Outside  Both How long have you owned this pet? _____________________	2. Time Away From Home  Home all day  Out part-time  Away 7-10 hours daily
Type ________________ Name _______________ Age ________ Sex _____ Spayed/Neutered  Yes  No Kept r Inside  Outside  Both How long have you owned this pet? _____________________	3. Our Dog Will Live:  Indoors only  Indoors/Outdoors  Outdoors only
Type ________________ Name _______________ Age ________ Sex _____ Spayed/Neutered  Yes  No Kept r Inside  Outside  Both How long have you owned this pet? _____________________	4. Home Atmosphere  Grand Central Station  Some activity  Zen-garden serene




Past Pet History

Please Describe Your Ideal Dog




Type ________________ Name _______________ Age ________ Sex _____ Spayed/Neutered  Yes  No Kept r Inside  Outside  Both How long have you owned this pet? _____________________
Type ________________ Name _______________ Age ________ Sex _____ Spayed/Neutered  Yes  No Kept r Inside  Outside  Both How long have you owned this pet? _____________________
Type ________________ Name _______________ Age ________ Sex _____ Spayed/Neutered  Yes  No Kept r Inside  Outside  Both How long have you owned this pet? _____________________