Animal Interested in Adopting::  
                        
                            First and Last Name:  
                        
                            Daytime Phone:  
                        
                            Evening Phone:  
                        
                             Email::  
                              
                         
                        
                            Confirm Email:  
                        
                            Street address, city, state, zip:  
                        
                            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 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