Adoption Application

*(denotes required field)

E-Mail Address: *

Which pet(s) are you interested in? *

Why do you want this particular pet? *

Name of Applicant (First & Last): *

Name of spouse or significant other:

If this relationship were to change, who would keep the pet?

Daily caretakers age?

If you have children, what are their ages?

Please list any additional people in the household:

Address: *

City: *

Zip code: *

Drivers License Number/State:

Home Phone(include area code): *

Cell Phone(include area code):

Work Phone(including area code):

Occupation: *

Employer: *

Do you live in a: *

House
Apartment
Condo
Other

Do you own or rent? *

Own
Rent

If renting, do you have your landlords permission to have a pet?, Yes, No

Landlords or HOA Assoc. Name & Phone Number (REQUIRED if you RENT):

How long have you lived at this address? *

If you are in an apartment or condo, what is the pet weight limit?

Will the pet be an indoor or outdoor pet? *

Indoor
Outdoor
Both

How many hours will this pet be inside? *

How many hours will this pet be outside?: *

How long will the pet be left alone each day? *

Where will the pet be left when alone: *

Will the pet be allowed on the furniture? *

Yes
No

Will some furniture be off limits? *

Yes
No

If yes, what furniture will be off limits?

Will the pet be allowed in all areas of the house? *

Yes
No

If no, which areas will be off limits?

Where will the pet sleep at night? *

Outside
Pet bed inside home
Crate inside home
Bedroom
Garage
Other

If other, please describe:

What brand of food will you feed your pet? *

Are you open to learning about proper pet nutrition? *

Are you willing to learn about updated vaccinations protocols?, Yes;No *

What type of exercise will you provide? *

Do you have a backyard? *

Yes
No

Is your bakyard fenced?, Yes;No

Height of fence:

Type of fence:

Latched gates?

Yes
No

Locked gates?

Yes
No

Will this be your first dog/cat? *

Yes
No

Please list any pets that you currently have in your household:

Are ALL other pets spayed or neutered?

Yes
No

If you have cats are they indoor or outdoor?

Indoor
Outdoor

If you have a cat/s are they declawed? *

Yes
No

If the cat/s are declawed, please explain why:

Please list pets you currently have and have had in the past:

Pet #1 Breed:

Male or Female

Male
Female

Length of ownership:

Still own?

Yes
No

If yes, how old is this pet?

If no, what happened to this pet?

Pet #2 Breed:

Male or Female:

Male
Female

Length of ownership:

Still own?

Yes
No

If no, what happened to this pet?

Pet #3 Breed:

Male or Female

Male
Female

Length of ownership?

Still own?

If yes, how old is this pet?

If no, what happened to this pet?

Have you ever been in a situation where you were not able to keep a pet? *

Yes
No

If you have given a pet away before, please explain:

Were you ever in a situation where you had to bring a pet to a shelter? Please explain:

What will happen to your pet(s) if you move? *

Do you have plans for your pet(s) in the event of your death? *

Yes
No

About Your Veterinarian

Who is your Veterinarian? *

Address: *

City: *

Zip code: *

Phone: *

What is a reasonable amount to spend if your pet became very sick? *

Does anyone in the home have animal related allergies? *

Yes
No

If yes, who?

What would happen if someone in the home developed allergies related to the new dog/cat? *

How will you train this pet? *

Obedience school
Spray bottle
Firm verbal commands
Swat with newspaper
Other

What will you do if the pet has accidents in your house?

Do you understand and accept that a change in a pet's environment may cause the pet to have accidents especially in the early days of the adoption? *

Yes
No

What will you do if the pet chews, digs, or has other bad habits? *

Are you prepared and able to take care of this pet for his/her entire lifetime? *

Yes
No

Do you have a friend or relative who would take this pet if you became unable to care for it? If yes, please list name and phone number:

Please estimate the annual cost of premium pet food, toys, vet care, grooming, etc. for your new pet: *

Dog Adoptions

Do you plan to take your new dog to obedience school?

Yes
No

If you answered no, please explain why:

Are you willing to housebreak a dog? If yes, using what method?

Will you walk/exercise this dog on or off leash (or both)? If off leash, where?

Cat Adoptions

Do you plan to declaw? If yes please read this article.

Yes
No

What do you plan to do if your cat scratches your furniture or humans?

Do you understand that changes in a cats environment, stress, and illness may cause a cat to urinate/defecate outside of the litterbox?

Do you agree to have your cat medically and behaviorally checked in this situation?

Yes
No

Personal References and Agreement Information

Please list 3 non-family references, whom we can call, and contact information: *

The adoption fee is $150. We are a 100% volunteer run organization; the adoption donation is used to partially recover the costs involved in rescuing the animal you are interested in. These costs include but are not limited to; Animal Shelter Fees, Spay/Neuter, Food, Housing, Vaccinations, Deworming, and any Veterinary Exams, or Medical Care that the animal may have required. We would not have been able to save the life of the animal you applied to adopt without the adoption donation from another that came before him or her.

What circumstances would cause you to give up a pet? *

If you were unable to keep this pet would you return it to I Once Was Lost Animal Advocacy as required by our adoption contract? *

Yes
No

We reserve the right to inspect all potential homes and yards prior to placement.

Is this agreeable to you? *

Yes
No

I have read the above information carefully and have filled out this application honestly. I understand that omission of information and/or failure to answer all questions can result in the application being declined. Also, if an omission or untruth is discovered after an adoption takes place, I understand and accept that Adette Quintana has the right to annul the adoption and reclaim the pet. If applicable I also agree to spay/neuter this pet(s) at or about 3 months of age and email/mail/or fax proof to Adette Quintana. If any circumstance arrives and I cannot keep this pet I will contact Adette Quintana. I also agree to keep this pet on heartworm preventative for his/her entire life.

This application becomes a part of our Adoption Contract. *

Agree
Disagree

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