Animal Interested in Adopting::
First and Last Name:
Daytime Phone:
Evening Phone:
Email::
Confirm Email:
Street address, city, state, zip:
please enter all this info
Name of veterinary clinic for current and/or past pets (where your pet received their most recent vaccines)::
Phone number of veterinary clinic for current and/or past pets::
Person's Name on Veterinary Account::
Please list all current pets (names, breeds, sex and ages)::
Please list all pets (excluding your present pets) you have had in the past 5 years, and where they are now::
If deceased, what were the causes::
Are your past/present pets spay/neutered?:
Are all your past and present pets current on vaccinations and heartworm preventative (dogs)?:
What vaccinations or treatments will you keep your new pet current on?:
What brand of food do you plan to feed your new pet?:
What is your estimated annual cost of care for the pet you are thinking of adopting?:
What would you do if emergency or general medical care exceed $1,000 dollars?:
Type of residence::
HOUSE
APARTMENT
TOWNHOUSE
CONDO
FARM
OTHER
How long have you lived at the current address?:
Do you rent or own?:
If renting, lanlord's name, phone #:
My yard is::
Please check all that apply. How do you plan to give your pet daily exercise?
Fenced in yard Leash walk Jogging/running Dog Park Day care Toys Dog door Other pets Fetch Hiking Off leash walks
Type of pet you were thinking of adopting::
DOG
CAT
KITTEN
PUPPY
Reason for wanting to adopt a new pet::
How long have you been considering adopting a new pet?:
Are you seeking a:
Pure Breed
Specific Breed
Mixed Breed
Specific Breed Mix
Any
What breed of pet are you seeking to adopt?:
What size of a pet are you seeking to adopt?:
Small (less then 20lbs)
Medium (20-50lbs)
Large (50-80lbs)
Extra Large (80+lbs)
Any
What age of a new pet are you seeking?:
Baby (8 weeks-4 months)
Puppy/Kitten (4 months- 6 months)
Young (6 months-3 yrs
Adult (3 yrs-10yrs)
Senior (10+ yrs)
Any
Will the pet be kept outside or inside the majority of the time?:
Will the pet have unattended access to outside?:
What is the maximum length of time the pet will be outside unattended?:
When outside, where will your pet be kept?:
Please check how/where your pet will relieve themselves:
Fenced yard Un-fenced yard Leash walk Outside kennel Yard pully run Doggie door Litter box Indoor puppy/wee-wee pads Free roam
Briefly describe how your pet would spend their day::
How many hours a day do you have to devote to your pet's care?
Number of hours pet will be home without human companionship?:
Where will your pet be kept while you are away?
Please check the applicable daily activities, if any, that your pet will have while you are away:
Day Care Petsitter
Where will the pet be kept at night?:
Please check the applicable daily or other activities, if any, you and your pet will partake in:
Dog Park Jogging Play Walks
Flyball Disc Dog Coursing/Racing Pulling
Hunting Herding Working Schutzhund/protection
Obedience Training Agility Training Puppy Training
Therapy dog Canine Good Citizen Search/Rescue
Camping Hiking Boating Travel
What is the preferred activity level of the new pet you are seeking?:
Non-active/mellow
Low activity
Medium activity
High activity
Extra-high activity
Please describe the type of personality/activity level of a new pet that would best fit your lifestyle (example: running comapanion, etc.):
What behavior would cause you to return your pet to the adopting organization?:
Concerns you or your family may have about adopting a new pet::
Have you adopted a pet from another organization before?:
Have you ever brought an animal into a shelter before, if so, when where and why:
If yes, where and when, and pets name::
Do any family members have known allergies to pets?:
If yes, please explain::
What coat preference do you have for your new pet?:
Short
Medium
Long
Non-growing/non-shedding
Growing/non-shedding
Any
What is your preferred amount of necessary grooming care?:
Professional bathing and cut
Home bathing and cut
Professional bathing as needed
Home bathing as needed
Daily brushing and care
De-shedding/brushing (longer coats)
Any
What is the activity level of your household?:
Non-active/mellow
Low activity
Medium activity
High activity
Extra-high activity
Number of adults in household::
Household relationship status:
Married
Single
Significant Other
Roomates
Number and ages of children in household::
Do children visit your home?:
Ages of children that visit your home:
Who will be the responsible caregiver of your new pet? If another, what is their relationship to you?
Employer name, address and phone number::
secondary (if applicable) caregiver's employment position and title:
Your work schedule:
Full Time
Part Time
Homemaker
Retired
Unemployedd
Your secondary' caregiver's (if applicable) work schedule:
Full Time
Part Time
Homemaker
Retired
Unemployed
Please provide the name and telephone #s of three personal references (non-family) that can be contacted as part of our routine screening process. Examples of acceptable references would be neighbors, co-workers, employers, fellow club or church members, etc.::
Type of Application::
ADOPTION APPLICATION
FOSTER HOME APPLICATION
By completing, and submitting the adoption application, you are agreeing that you are 21 years of age or older; you agree to the liability waiver (below); and ARA has the right to verify any information on the application.: *
First and Last Name:: *
By checking this box you agree to the terms of the liability waiver