Matching Application Step 1 of 10 10% Your Contact InformationYour Name* First Last Are you over 21 years old?* Yes No Address & Contact InformationAddress* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Email* What is generally the best time of day to call you to discuss your application?* Weekdays - Business Hours Weekdays - Evenings Weekends - Daytime Weekends - Evening Adoption InterestI am interested in adopting a:* Puppy Dog Kitten Cat The best match for my lifestyle based on your recommendation If you are interested in a specific shelter cat or dog, please put their name here: Is this your first experience with a pet?* Yes No Please tell us why you are interested in adopting a pet:* Reference InformationDo you currently own any pets?* Yes No If "Yes", please list below:Have you owned other dogs or cats in the past 5 years?* Yes No If "Yes", please tell us what happened to those pets.Your Veterinary Clinic* (please enter NA if you have not previously had a pet)Your Veterinarian's Name* (please enter NA if you have not previously had a pet)Your Veterinarian's Phone Number*(please enter NA if you have not previously had a pet)What name are your pet's veterinary records under?* (please enter NA if you have not previously had a pet)Personal ReferencePlease provide one friend or family member referenceName* First Last Phone* Matching - Home & HouseholdType of home:* House Apartment Mobile Home Duplex Condominium Other If "Other", please explain:Are you renting your home?* Yes No If renting, do you have approval to have a pet? Yes No If approved, are there any size or breed restrictions on the types of pets you can have?* Yes No Your landlord's name: Your landlord's phone:How long have you lived in your current residence?* How many people live in your household?* Is everyone in the house in agreement with adopting a pet?* Yes No Are there children in your household?* Yes No If "Yes", please list the ages of children in the householdWhose responsibility will it be to feed, water and care for the pet?* Is anyone in your household allergic to animals?* Yes - Dog Allergies Yes - Cat Allergies Yes - Cat & Dog Allergies No Allergies Will this pet be indoor or outdoor?* Inside Pet Outside Pet Indoor and Outdoor Do you have a fenced yard?* Yes - Chain Link Yes - Wood Privacy Yes - Farm Fencing or Welded Wire Yes - Wrought Iron No (All 4 corners must be fenced, if multiple fence types, select all that apply)If "Yes", what is the height of the fence? Height of fence: Do you have a swimming pool?* Yes - Fenced, Above Ground Yes - Unfenced, Above Ground Yes - Fenced, In Ground Yes - Unfenced, In Ground No swimming pool Where will the dog or cat be kept during the day?* Inside house Day Care Crated Fenced yard Kennel/run Loose in unfenced area Tied out Garage Other If "Other", please describe:Where will the dog or cat be kept at night?* Inside house Day Care Crated Fenced yard Kennel/run Loose in unfenced area Tied out Garage Other If "Other", please describe: Matching - Current PetsPlease list any current pets you have, name, type, age, spayed or neutered, length of time owned and if they are current on vaccinations:Have you had any other pets in your adult life? ** Yes No If yes, how long did you own them and what happened to them?For dog applicants only - What brand of heartworm prevention are your current dogs on? Do your current pets get along with the type of pet you are adopting?* Yes No Other If "Other", please explain: Matching - PreferencesWhat kind of traits are you looking for in your pet?*What do you consider undesirable traits?*What is the approximate adult weight of the pet you are looking for?* What is the activity level of the pet you are looking for?* What gender do you prefer?* Male Female No preference Reason for the gender preference?* Matching - LifestyleWhat are some activities you'd like your new pet to do with you?*What role will this pet fulfill for you?* Companion Protector Company for other pet Couch potato companion Friend for child/children Household pet Other If "Other", please explain:For dog applicants only - What training are you interested to do with your new pet? Basic obedience Advanced obedience Agility / specific skills Therapy pet Other How many hours are you typically away per day?* 0-4 4-8 8-12 12+ How many hours a day do you plan to share with the pet?* Do you anticipate any significant changes in the upcoming year?* New Baby Move to Apartment Move to House New Job Relocation Military Service/deployment No Significant Changes Other If "Other", please explain:What plans do you have for the dog or cat if any of the above occur?* Future ConsiderationsHow will you transport your pet?* Loose in car Seatbelted in Car Crated in car Inside cab of truck For dog applicants only - Do you plan to let your dog off leash when not in a fenced in area?* Yes No Maybe Who will care for the pet if you are traveling or unavailable?* Do you have a long-term plan in place if you were no longer able to care for the pet or if the pet outlives you? (Please explain)*What will you do if the pet displays bad behavior such as barking, digging, chewing, scratching etc?*What would you consider a legitimate reason for “giving up” a dog or cat?* CommitmentsHeartworm Information Heartworms are parasites transmitted by mosquitoes to your dog. They live and grow in the heart, eventually producing enough worms that the heart can no longer function and the dog dies. Treating a dog for heartworms is both expensive ($500-$1000) and very hard on your dog’s system because the treatment used to kill the worms can be fatal. Heartworms are, however, very easily prevented with a monthly heartworm preventative. Your dog will need to be on heartworm prevention for the rest of its life. Are you willing to commit to this level of care?Heartworm Confirmation* Yes I commit to this care NA - I am interested in adopting a cat At minimum the pet will require a yearly vet exam and vaccinations. Often dental care and other procedures may be required. Are you committed to this level of care for the rest of the pet’s life?Vet Confirmation* Yes I commit to this care There are times when unexpected and often very expensive medical conditions occur. Are you committed to providing whatever medical care your veterinarian deems necessary for you pet?Medical Care Confirmation* Yes I am prepared to provide medical care to this pet Δ
