Animal Welfare, Inc.

Non-profit humane organization helping pets and 
   pet ownersPrograms include spay and neuter subsidy, pet 
   care, education, ID tags, etc

Home Page

Spay / Neuter Vouchers

Pets Looking For New Homes

What if YOU have a Pet to Re-Home?

Links - Rescues, Lost & Found, and More

Programs and Projects

Become a Member / Make a Donation

Sponsors / Supporters

Wish List

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Happy Endings


Highlight, Copy, and Paste the Entire Application below. Paste the application into an Email message, edit in your information, and then send it all back for processing.
Thank YOU !


Application

Which Pet are you Interested in? ____________________________

Date of Application: ___________________________

Name: __________________________________________________ Home Phone: (______)_________________________
Spouse’s Name: __________________________________________ Cell Phone(s): (______)_________________________
Address: _________________________________________________ Apt # ______________
City: _____________________________________ State: ________________________ Zip: _____________
Email Address: ________________________________________________
Date of Birth: ___________________________
1. Do you live in a [ ] Condo/Townhouse [ ] Apt. [ ] Duplex [ ] Mobile Home [ ] House [ ] Other
2. Do you [ ] Rent/Lease [ ] Own your residence [ ] Live with Parents or Friends
3. If you rent, is your rent/lease [ ] Monthly or [ ] Yearly?
What is the Name of the Complex, Association, Landlord, or Owner? _________________________________________
__________________________________________________ Phone # for Landlord: (_______)_____________________
Pet Policy? ____________________________________________ Amt. Of Pet Deposit? _______________
4. How long have you been at this address? _____________
If you have been at this address less than 1 year, what was your previous address? ________________________________
______________________________________________________________________________________________________
How long were you at your previous address? _________________

5. How many Adults reside in the household? _______ How many Children? ______ Ages of Children? ____________________
6. Do you smoke? __________________________ Does your mate/spouse smoke? ____________________
7. Employer’s Names: __________________________________________________________________________________
How long working there? _______________________________ Phone Number: (____) _______________________

Military ONLY – Please list 2 persons that would care for your pet if you are deployed or gone to special training.
1. Name: ___________________________________________________________ Relationship: ______________________
Address: ____________________________________________________________________________
Phone Numbers: ______________________________Email: __________________________________
2. Name: ___________________________________________________________ Relationship: ______________________
Address: ___________________________________________________________________________
Phone Numbers: _____________________________Email: __________________________________

8. Have you ever turned an animal over to an animal shelter? ___________________________________________
If yes, when and why? __________________________________________________________________________________
9. Have you ever had to find a home for one of your pets? ______________________________________________
If yes, when and why? __________________________________________________________________________________
10. Would there be anybody at home during the day? ___________________________________________________________
If yes, who? _________________________ If no, how long would the pet be left unattended? __________
11. Does it matter if the pet is housebroken? ___________________________________________________________________

12. Do you have any Dogs and/or Cats at home now? _________________
Name: ___________________ Age: _______ Breed: ____________ Sex: _______ Spayed/Neutered: _____________
Inside or Outside: _________ Heartworm Prev. ____________ Brand: ______________________________
When & Where did you get the pet? ___________________________________________________________
Name: ___________________ Age: _______ Breed: ____________ Sex: _______ Spayed/Neutered: _____________
Inside or Outside: _________ Heartworm Prev. ____________ Brand: ______________________________
When & Where did you get the pet? __________________________________________________________
Name: ___________________ Age: _______ Breed: ____________ Sex: _______ Spayed/Neutered: _____________
Inside or Outside: _________ Heartworm Prev. ____________ Brand: _____________________________
When & Where did you get the pet? __________________________________________________________
Name: ___________________ Age: _______ Breed: ____________ Sex: _______ Spayed/Neutered: _____________
Inside or Outside: _________ Heartworm Prev. ____________ Brand: _____________________________
When & Where did you get the pet? __________________________________________________________
Name: ___________________ Age: _______ Breed: ____________ Sex: _______ Spayed/Neutered: _____________
Inside or Outside: _________ Heartworm Prev. ___________ Brand: _______________________________
When & Where did you get the pet? ___________________________________________________________
12b. Do you have any other pets? _____________ What kind? ___________________________________________________

13. What Animal Hospital/Clinic do you currently use? _____________________________________________________
Address and Phone: ______________________________________________________________________________
Date and reason of last visit? _______________________________________________________________________
14. What previous Animal Hospital/Clinic did you use? _____________________________________________________
Address and Phone: ______________________________________________________________________________
15. What type/brand of pet Food have you fed in the past? ___________________________________________________
16. What type/brand of pet Food do you plan to feed your new pet? ____________________________________________
Why this food? ___________________________________________________________________________________

17. Have you had pets in the past 10 years? ________________________
Name: _________________ Age: ______ Breed: __________ Sex: _______ Spayed/Neutered: _________
Inside or Outside: _________ Heartworm Prev. ____________ Brand: ______________________________
When you got the pet? _______________________When did you loose the pet? ________________________
What Happened? ___________________________________________________________________________
Name: _________________ Age: ______ Breed: __________ Sex: _______ Spayed/Neutered: _________
Inside or Outside: _________ Heartworm Prev. ____________ Brand: ______________________________
When you got the pet? _______________________When did you loose the pet? ________________________
What Happened? ___________________________________________________________________________
Name: _________________ Age: ______ Breed: __________ Sex: _______ Spayed/Neutered: _________
Inside or Outside: _________ Heartworm Prev. ____________ Brand: _____________________________
When you got the pet? ______________________When did you loose the pet? ________________________
What Happened? ___________________________________________________________________________
Name: _________________ Age: ______ Breed: __________ Sex: _______ Spayed/Neutered: _________
Inside or Outside: _________ Heartworm Prev. ____________ Brand: _____________________________
When you got the pet? ______________________When did you loose the pet? ________________________
What Happened? ___________________________________________________________________________
Name: _________________ Age: _____ Breed: __________ Sex: _______ Spayed/Neutered: _________
Inside or Outside: _________ Heartworm Prev. ___________ Brand: _______________________________
When you got the pet? ______________________When did you loose the pet? _________________________
What Happened? ___________________________________________________________________________

18. Has anyone in the household ever had allergies to animals? __________________________
If yes, who and what did you do? _____________________________________________________________________
19. Is this pet a gift? ________________________________
If yes, for who? ___________________________________________________________________________________
20. Where will the pet be when no one is home? ______________________________________________________________
21. If outside, is shelter provided? ______________ What type of shelter? _________________________________________
22. If outside, how will your pet be confined? _______________________________________________________________
[ ] Chain [ ] Fenced Yard [ ] Garage [ ] Dog House [ ] Kennel/Pen [ ] Patio
[ ] Trolley [ ] Crate [ ] Other: _______________________________________________

23. Do you have a fenced yard? ______________ What height is your fence? _________________________________
What type of fence: [ ] Chain Link [ ] Wood [ ] Other: __________________________________________
24. Where will the pet sleep? ______________________________________________________________________________
25. Are you aware of the need for heart worm prevention? __________________________________________
Do you agree to keep the dog on heart worm prevention? _________________________________________________
How much do you think heart worm prevention will cost per Month? ___________________________________________
26. How much Money do you think it will cost to care for your new pet for 1 Year? ___________________________________
27. Why do you want to adopt a pet? _________________________________________________________________________
28. How long have you been looking for a pet? _________________________________________________________________
29. Who will be responsible for taking care of the pet? ___________________________________________________________
30. Are you planning on taking the dog through obedience training? ________________________________________________
31. Are you aware that when bringing a new pet into your home, there is an adjustment period that can take up to a
month on up to 1 year? _______________________________
32. Are you aware that from time to time pets can damage your belongings, soil your furniture and/or flooring, scratch furniture,
chew and tear up items, knock down breakable heirlooms, and/or dig up your yard? ________________________________
33. How and where will you exercise your dog? ________________________________________________________________
34. How do you plan to housebreak your dog? _________________________________________________________________
35. How will you handle your cat scratching on your furniture? ___________________________________________________
36. How will you handle your cat or dog running out the door and outside? ___________________________________________
37. If you own a pick-up truck, will you let your dog ride in the back? _______________________________________________

38. Do you have a swimming pool on your property? ____________________
If Yes, is there a fence around it? _______________________ What type of fence? __________________________________
39. Pets often live 15-20 years – Are you ready and willing to take the time, responsibility, and have the
money necessary to take care of your dog for its entire lifetime? ____________________

40. IF YOU HAVE NEVER HAD A PET BEFORE....List the Names, Addresses, & Phone numbers of 3 references we
may call who can attest to your suitability as an Adopter.
For example - an animal professional, trainer, veterinarian, groomer, educator, employer, etc.
1. Name: ____________________________________________ Phone #: __________________________________
Address: __________________________________ City/State/Zip: ________________________
Email: ________________________________________________ Relationship: ______________________________
2. Name: ___________________________________________ Phone #: ___________________________________
Address: __________________________________ City/State/Zip: ________________________
Email: ________________________________________________ Relationship: ______________________________
3. Name: ___________________________________________Phone #: ___________________________________
Address: __________________________________ City/State/Zip: ________________________
Email: ________________________________________________ Relationship: ______________________________

41. Have you ever applied for adoption before? _____________________ When:? _____________________________________
Which shelter or agency? _______________________________________________________________________________
Which Pet did you adopt from them? ______________________________________________________________________
If you were denied the pet, what was the reason? _____________________________________________________________
42. Have you ever applied for adoption from another shelter or agency? ____________ When? ____________________________
Which shelter or agency? _______________________________________________________________________________
Which Pet did you adopt from them? ______________________________________________________________________
If you were denied the pet, what was the reason? _____________________________________________________________
43. Do you travel for business or vacation? __________ Who will care for your pet while you are away? _____________________
_____________________________________________________________________________________________________
44. Have you thought about how a pet will affect your daily lives? __________________________________________________
45. Have you thought about how a pet will affect your lives in times of stress, unemployment, marriage, birth, divorce, moving,,
and other events? _____________________________________________________________________
46. Do you realize that having a pet is a great Responsibility much like having a human toddler? ________________________
47. What will you do for your pet if you have to move? __________________________________________________________
48. How will you train your dog and children - current & in the future? _________________________________________
____________________________________________________________________________________________________
49. Would you object to having a representative visit your home to check on the pet? __________________________________

I, ___________________________________________________________, hereby certify that the above information is true and correct
to the best of my knowledge. Falsification of information may be deemed cause for denial of this application for adoption, and the pet may
be reclaimed by the Rescuer and/or may result in legal action.

By signing this application, I authorize the Rescuer to contact my landlord, veterinarian, relative, employer, or reference contacts to verify
any or all information given and in the future to verify the care of the pet.

I also understand that, if for any reason, I am no longer able to take care of an adopted pet, I am obligated and MUST return the pet to
Rescuer. Before returning the pet, I agree to give Rescuer, a minimum of ten days advance notice.

I understand that I /we may be denied a pet for any reason.

Date: _____________________ Applicants Signature: _____________________________________________

Date: _____________________ Applicants Signature: _____________________________________________

THERE IS ALWAYS AN ADJUSTMENT PERIOD WHEN BRINGING A NEW PET INTO YOUR HOME.
SOMETIMES THE ADJUSTMENT MAY BE A MONTH OR SO, PLEASE BE PATIENT WITH YOUR NEW COMPANION
AND SHOULD YOU HAVE ANY QUESTIONS, PLEASE DO NOT HESITATE TO CALL US FOR ASSISTANCE.

THANK YOU FOR OPENING UP YOUR HEART AND YOUR HOME TO A HOMELESS ANIMAL !

E-mail Application!