Name___________________________________Spouse/Partner________________________
Address___________________________________________City____________Zip_________
Your
Age Range: 20s ____ 30s ____ 40s ____ 50s ____ 60s ____ 70s ____ Older ____
Partner's Age Range: 20s ____ 30s ____ 40s ____ 50s ____
60s ____ 70s ____ Older ____
Do you Own? House___ Apt ___Condo ____ Other ________How long?_______
Do you Rent? House ___Apt
___Condo____ Other________ How long? _______
If renting, does owner/mgt allow animals? _____ Is it written in your lease?
____
Interest in: CAT___ DOG ____. Male ____ Female ____ Either ___ Specific Breed?___________
Interest in: CAT___ DOG ____. Male ____ Female ____ Either ___ Specific Breed?___________
Special Characteristics______________________________Specific Animal________________
Approx Weight Range _______ Age Range _______ How soon do you want
him/her? __________
HOME PHONE___________________ Work______________Cell__________________
FAX_____________ E-Mail Address___________________
If you're interested in adopting a cat,
will you have the cat declawed? _______
If you're interested in adopting a cat, do you plan to keep him/herL Indoors ____Outdoors ___ Both ____
Why do you want to adopt an animal?_____________________________________________
Is the animal a gift? ______ Are you familiar with this breed? ______
How many animals have you had in the last five years?_____ What kind(s), breed(s), sex
If you're interested in adopting a cat, do you plan to keep him/herL Indoors ____Outdoors ___ Both ____
Why do you want to adopt an animal?_____________________________________________
Is the animal a gift? ______ Are you familiar with this breed? ______
How many animals have you had in the last five years?_____ What kind(s), breed(s), sex
& ages_____________________________________________________________________
What animals are at home now?
Names, breed, sex, ages? ___________________________________________________________________________
What happened to those no longer
with you? If died, causes of death: ___________________________________________________________________________
Have they all been
spayed/neutered?___________ If not, why not?________________
Veterinarian or Pet Hospital Reference: __________________________________________
Personal Reference: Name / City / Phone__________________________________________
# of Adults in the home_____ # of Children at home ______
Veterinarian or Pet Hospital Reference: __________________________________________
Personal Reference: Name / City / Phone__________________________________________
# of Adults in the home_____ # of Children at home ______
Names, Sex & Ages of children at home________________________________________
Do all members of household want an animal? ________Who
will be primarily responsible ________
_________________________ Allergies? ________
Who will be responsible if something were to happen to you?_____________________________
Who will be responsible if something were to happen to you?_____________________________
WHAT IS YOUR OCCUPATION? _____________________WHERE?_________________
Spouse/Partner's occupation?____________________Where?________________________
HOW MANY HOURS are you away from home each day? _________ HOW MANY HOURS is your spouse/partner away from
home? ________Where will the animal stay during the day? (be specific) ________________________
Where will the animal sleep at
night_______________________________________
How many stories in your apt. or house? _____Do you have screens on your windows?______
a
yard? _____ a patio?______ fenced? ______ Height?______
When/If you go away, who will care for the animal? _____________________________
How
long do you expect to keep this animal? __________________
Under what circumstances would you surrender him/her?_________________________________________________________________
If
dog needs obedience training, are you willing and able to do this? __________ If dog needs house training, are you willing and
able to do this? _________In case your animal had an emergency or serious illness, how much would you be willing/able to spend
on veterinary care? $100 ____ $250 ____ $500 ____ $1000 ____ Whatever it takes _____
Would you object to an All Creatures' representative visiting your home, either before or following
an adoption? ______
Would you be willing to foster a dog while waiting for your preferred permanent dog? _________
How did you learn about All Creatures? Petfinder? ______ 1-800-save-a-pet _______ flyer ____
Referral
_______ Name _______________ allcreaturesmarin.org website ________
Other _____________________________
Additional information for us to consider regarding the animal you want: _______________________________________________________________
Additional information for us to consider regarding the animal you want: _______________________________________________________________
____________________________________________________________________
Signature(s)
_________________________________________________
Date: ______________
All Creatures Animal Caring Society ~ P. O. Box 3664, San
Rafael, CA 94912
Office: 415-456-1941 ~ Fax: 415-456-2003 ~ e-mail, click on:
E-Mail Address: lyncat1@sbcglobal.net www.allcreaturesmarin.org