APPLICATION FORM - SOUTH FLORIDA PET PERFECT CAMPAIGN

ADOPTION APPLICATION FORM - PET RESCUE

Date:______________ _____Dog Application _____Cat Application

Name:____________________________________________

Address: _______________________________________________APT. # _______

City:______________________ County: _____________State: FL Zip:____________

TELEPHONE NUMBERS: HOME:___________ MOBILE (Optional): _______________

E-Mail Address (Optional):______________________________________

Employer's Name: _____________________________________________

Telephone Number: _______________w many years have you worked here? ______

Driver's License #_________________________State: _____________________

Name of nearby Relative or Friend: ______________________ Phone # ___________

1. How did you hear of us?_______________________________________________

2. Indicate type of dwelling that you live in: ___house ___townhouse ___mobile-home
___condo ___apartment ___duplex ___boat ___dormitory _______________other

3. How long have you been at this address? __________
Is there an enclosed, outside area and, if so, approximately how large? ____________

4. Do you _____own or do you ____rent?

5. If you rent, is your lease: ___yearly ___month-to-month ___week-to-week?

Name of Landlord/owner:_________________________ Phone # _______________

Has the Landlord/owner ___approved ___denied ____has not been informed

Landlord has approved but with the following restrictions:_______________________

6. Name of condominium or complex association:______________________________

List any restriction regarding pets:________________________________________

7. How many adults reside in the household? _______________

8. How many children are in your home? ______ Ages: _________________________

9. What type pet are you looking for: ____dog ____puppy ____cat _____kitten.

10. Have you ever turned in an animal to an animal shelter?
If yes, please provide reason:____________________________________

_____________________________________________________________

11. Does it matter if the pet is housebroken? _____yes ____no

12. Will there be anyone home during the day? If yes, who? _______________________

13. Has anyone in the household had an allergy to animal hair? _____yes ____no

14. How many pets have you had in the last 5 years? ___________
If you no longer have any of these animals, what is the reason?_______________

__________________________________________________________________

What brand of food did you feed the previously owned pets?___________________

15. Please list the dogs now living with you. If more than 4, how many? _________

Name ___________________ Neutered/Spayed ____yes Breed _____________ ___male/__female

If any are not neutered/spayed why?____________________________

Are they up-to-date on all their vaccines? ___yes ___no ____I am not sure.

Are the dogs kept ___indoors ___outdoors ____both

What brand of food are you presently feeding? ___________________________

16. Please list the cats now living with you. If more than 4, how many? _________

Name ___________________ Neutered/Spayed ____yes ___male/__female Declawed? ____yes

If any are not neutered/spayed why? ______________________________________

Are they up-to-date on all their vaccines? ___yes ___no ____I am not sure.

Have the cats been tested for feline leukemia? ___yes ___no ____I am not sure.

Are the cats kept ___indoors ___outdoors ____both

What brand of food are you presently feeding?______________________________

17. Would your new pet be living ___indoors ___outdoors ____both.

18. Will you declaw your new pet? If yes, why_________________________________

19. Where will your new pet sleep? ___________________________________

20. Is there a ground-floor patio, balcony, or porch where your pet can access?
___yes ___no ___ Is this screened in? ___yes ___no ___
Is there an upper-floor balcony or porch where your pet can access?
___yes ___no ___ Is this screened in? ___yes ___no ___
This is an important consideration as pets are known to leap off balconies.

Is this screened in? ___yes ___no ___

21. Have you had to deal with Florida's flea problem? ___yes ___no ___

How do you plan to keep a flea and tick free environment?______________
______________________________

22. Who is your veterinarian? ____________________________
Phone # ____________________

Which hospital do you use? ____________________location:________________

23. Why do you want to adopt a pet?__________________________________

_________________________________________________

24. I, ___________________________________________
agree that all the information which I have
given is correct as written.

Signature: ________________________________________