TELL US ABOUT YOURSELF
Name*
First Last
Address*
Please note, we are located in Noblesville, Indiana, USA.

Street Address Address Line 2 City State ZIP Code
Email*
Driver's License Number*
Date of Birth*
Date Format: MM slash DD slash YYYY
Cell/Other Phone*
Home Phone
Work Phone
Emergency Contact*
Please, list someone other than yourself.
First Last
Emergency Contact Phone*
Are you at least 18 years of age?*
- Yes
- No
Are you at least 21 years of age?*
- Yes
- No
Have you ever surrendered a personal pet to this or any other shelter/rescue group?*
- Yes
- No
Please, explain.
Please tell us what type of pet you are looking for:*
- Indoor Pet
- Outdoor Pet
- Indoor/Outdoor Pet
What would that look like in your household?*
Is any member of your household allergic to animals?*
- Yes
- No
If yes, they are allergic to:*
- Cats
- Dogs
- Both
Please tell us why you are wanting to adopt a pet
Select all that apply.
- Companionship for me/myself
- Companionship for my current pet(s)
- Protection
- Watch Dog
- Breeding
- Mouser
- He/She will be a gift
Please, explain.*

TELL US ABOUT YOUR HOUSEHOLD
Tell us about your current housing situation*
- Own my own home
- Own my own condo
- Renting an apartment/condo
- Renting a house
- Living with parents/relatives
- Live in a trailer/mobile home
- College Fraternity/Sorority Housing
Landlord's Name:*
First Last
Landlord's Phone Number:*

TELL US ABOUT YOUR FAMILY
Please tell us about your current household*
- Live Alone
- Adults Only
- Family with children
Are there children/grandchildren who visit your home?*
- Yes
- No
Please, list ages of each child that visits and how often they visit.*
Child Age Visit Frequency
Please, list the names and ages of all persons living in your home including yourself.*
Person Age
The activity level in your home is*
- Quiet
- Active
- Very Active
Do all members of your household know you are planning on adopting a pet?*
- Yes
- No
How will you confine a pet to your property?*
- Fenced Yard
- Garage
- Basement
- Crate
- Loose within residence
- Outdoor Kennel
If you have a fenced in yard, what kind is it?*
- Invisible
- 4 ft Chain Link
- 6 ft Privacy
- Other
Where will this pet be kept during the day?*
- Crate
- Restricted to 1 Room in Home
- Loose in Home
- Outdoor Kennel
- Tie-out in Yard
- Loose in Fenced Yard
Where will this pet be kept at night?*
- Crate
- Restricted to 1 Room in Home
- Loose in Home
- Outdoor Kennel
- Tie-out in Yard
- Loose in Fenced Yard
What will you do with this pet when you travel/go out of town?*
- Boarding Facility/Vet's Office
- Family or Friends Watch Them
- Leave Home Alone
- Take With You
What will you do with this pet if you have to move from your current dwelling?*
- Take With You
- Re-home to Family or Friends
- Return to Shelter
- Leave
If adopting a dog, are there any other dogs (other than your own) that this dog must get along with?*
E.g. relative's dog, neighbor's dog, significant other's dog, etc.
- Yes
- No
What training methods would you use to handle potential problems with your new pet?*
Barking and/or meowing, crate training issues, chewing/scratching, housebreaking, going outside the litter box, etc.

TELL US ABOUT YOUR PETS
Do you currently have any pets?*
- Yes
- No
How many pets do you currently have total?*
If yes, please check all that apply:*
- Cats
- Dogs
- Other
How many years have you owned these pets?*
What are their ages?*
Are they male or female?*
Are they spayed/neutered?*
Are they kept indoors, outdoors, or both?*
Are they current on vaccines?*
Name of your Veterinarian
Veterinarian's Phone

Adoption Application

Step 1 of 6

TELL US ABOUT YOURSELF

TELL US ABOUT YOUR HOUSEHOLD

TELL US ABOUT YOUR FAMILY

TELL US ABOUT YOUR PETS

Please tell us about your PAST pets (adult life only - past 10 years).

Previous Pet #1

Previous Pet #2

Previous Pet #3

Child	Age	Visit Frequency

Person	Age