Adoption Profile: Adoption Type: Dog Cat Other: Name of animal: Applicant Information: Legal Full Name (First, Middle Initial, Last): Maiden Name: Date of Birth: Driver s License Number: Please list the full names and birthdates of ALL other adults (over 18 yrs of age) that live in the home. If more than two, please write on back of form: Name: DOB: Name: DOB: Total number of children in your home: Ages of children: Current Address: Street Address City: County: State: Zip Code: Home/Cell Phone: Secondary Phone: Email address: Occupation or Source of Income: Employer: Current and Past Animal Information Please complete all sections because incomplete or inaccurate information may cause your application to be denied or not processed. * PLEASE LIST ANY PETS YOU NOW OWN OR HAVE OWNED IN THE PAST 5 YEARS * Name of animal Type (dog, cat, bird, etc.) Breed Kept In House? Y/N Age Altered? Y/N Gender M/F Where is the animal now? (Please list additional pets on the back of the application) P a g e 1 5
*You will need to contact your veterinary clinic to release vet records.* Vet Clinic s Name: Phone Number: Are all dogs and cats in home current on vaccines: Yes No Not Sure *Please contact your veterinarian to release records* Have you or a family member ever had to surrender/return an animal to a shelter or re-home with another person: Yes No If yes, please explain what kind of animal and the circumstances: Additional Information: Please circle the most accurate answer when appropriate Do you: Rent Own A/An: Apartment House Trailer Condo Landlord s Name: Phone Number: Have you spoken with your landlord about restrictions and fees? Yes No If yes, what are they: How long have you lived at this residence? Are you planning to move in the near future: Yes No If yes, please explain: Please specify your experience level with the type of animal you are applying for: What energy level are you seeking in your new companion? Please circle one: Very active Moderately active Not very active Quiet Other: How do you plan to exercise your new companion? How often? My reason for adoption this animal is: Circle all that apply Companion: For myself For kids For other pet Barn Cat/Mouser Gift Guarding Hunting Other: P a g e 2 5
If you have another pet, has she/he been around other animals in the past? Yes No Cats Dogs Explain: If you have other animals in the home, how do you intend to introduce them? Is there any member of your household that has allergies to any animal? Yes No If yes, to what type (s): Are they on medication for their allergy: Yes No If someone in the household develops allergies to the animal you are adopting, what is your plan? Please circle who will be responsible for the care of this animal: circle all that apply Myself Family Member Children Other: Do you have a plan for someone to care for your animal in the event you are no longer able to? Such as, moving, finical changes, injury, ect. Yes No Please explain: How many hours per day will this animal be left home without a person? If you travel, who will care for the animal and where? This animal will live: Strictly indoors Strictly Outdoors Indoors with outdoor time If adopting a cat, do you plan to let them outside: Yes No If yes, please explain: When the animal is inside they will be: circle all that apply Crated Confined to one room Basement Loose Tied P a g e 3 5
When the animal is outside they will be: circle all that apply Fenced yard Invisible fence Tied Walked Loose Loose supervised If adopting a cat: Are you planning to declaw: Yes If yes, please explain: No What are your training methods of choice if a behavior issue were to occur after you bring your new companion home? Are there behavior issues or special needs that you are not willing to work with? Please circle all that apply: Special Diet Vocal/Barking Jumping Litterbox Potty-training Dog Aggression Long term medication Other: Please circle the types of people and animals your new companion will need to be comfortable with: Large Dogs (40 lbs +) Small Dogs (30 lbs -) Cats Small Animals Other: Elderly Teens Children (6-12) Children (Infant-5 yrs) Other: Many of the animals at NAS came in as strays, so many do not have background information to share. Are you comfortable with allowing the animal a minimum of 1-2 months to adjust to the new home, settle into a routine, learn house-training and bond with you? Yes No Please list two references that do not live with you: Name: Phone Number: Relationship: Name: Phone Number: Relationship: How did you hear about our shelter: P a g e 4 5
Please read the information below carefully before signing the application. I understand that NAS has the right to accept or deny my application and will follow up on adoptions. I realize that NAS does not approve adoptions on a first-come, first-serve basis and adoption approval is based on the animal s best interest. I understand and agree that all pets in my household must be properly vaccinated before bringing my new pet home. I certify that I am at least 18 years of age and that the information I have given is true. I recognize that any misrepresentation of facts may result in my losing the privilege of adopting a companion animal. I am fully aware that I am adopting a living creature and, as such, that the Neenah Animal Shelter is unable to guarantee the health of the animal. If the animal I adopt becomes ill, I certify that I am financially and/or emotionally prepared to treat this animal at my expense. Signature of Applicant Date Please circle the items you would like emphasized at the time of adoption: Vaccines and annual veterinary exams Heartworm prevention Soft claws and declawing alternatives Other: Flea and tick prevention Proper exercise requirements Introductions to other cats or dogs Litter box training/litter Nutrition/Feeding Potty training Scratching posts Kennel training P a g e 5 5