First Name

Last Name

Email Address

Phone Number

Address

City

State

Zip

What type of pet are you looking for? What type of pet are you looking for? Dog Puppy Cat Kitten Other

Is there a specific pet you are interested in?

What best describes you: What best describes you: Looking for a companion pet for me Watchdog/Protection Companion for other pet(s) As a gift

Tell us about your household (e.g., # of adults/seniors/children living there or visiting often:)

Please check all that apply to your family’s / household’s lifestyle: Please check all that apply to your family’s / household’s lifestyle: Very Active/On the Go Quiet/Relaxed Noisy/Frequent Visitors Travel Frequently

If other, please explain

Does anyone in your home have allergies?

Do you currently: Do you currently: Rent Own Live with Family Other

What type of home do you live in? What type of home do you live in? Apartment House Dorm Other

If other, please explain

How many hours will your pet be left alone each day?

Where will your pet be kept when you are not home?

How do you plan on providing your pet with enrichment and exercise?

Are there any breed restrictions where you live?

Tell us about your other pet(s) at home (check all that apply): Tell us about your other pet(s) at home (check all that apply): We have no other pets We have small animal(s) We have one or more dog(s) We have one or more cat(s) Other:

If other, please explain

Are the other pets in your home spayed or neutered? Are the other pets in your home spayed or neutered? Yes No

If you answered no, please explain

We’ll explain your new pet’s medical and behavioral history. Check any additional topics you’d like to discuss: We’ll explain your new pet’s medical and behavioral history. Check any additional topics you’d like to discuss: Feeding this pet housing this pet House/Litter box training Crate training Puppy/Kitten proofing Trainer/Training Classes Exercise, toys, & fun activities Introducing other pets Finding a veterinarian Microchipping Flea/Tick Prevention Heartworm Prevention Grooming/nail trimming Declawing Moving with pets

Check any extra services or opportunities that you may be interested in: Check any extra services or opportunities that you may be interested in: Information on our veterinary clinics Information about fostering Information on supporting us with financial or in-kind donations Information on upcoming events Information about volunteering