Contact

Name:   Email Address:
Address: City, State, Zip:
Home Phone: Work Phone:

Reference:

Reference: Phone:
Relationship:

 

Home Information:

Do you live in: Pick One House House Rent Apartment Apartment Rent Condo Condo Rent Duplex Duplex Rent
How long lived there?
If rent, are animals allowed by your landlord? Yes No
Have you paid a pet deposit? Yes No
Landlord’s Name:
Landlord’s Address:
Landlord’s Phone:

If you move, are you prepared to find another residence
allowing pets? Yes No
# adults in the home:
# children in the home:
Children’s ages:

Do you or anyone in your household or immediate
family have allergies or asthma? Yes No
 

Is your yard fenced? Yes No
How high?
Type?

 

Your Pets:

Do you currently have pets? Yes No
If yes, types & ages 
List other pets you have had in the past
5 years:
Are your pets? Spayed/neutered? Yes No
Tested for Leukemia? Yes No
De-clawed? Yes No
Current on all vaccines? Yes No
Treated regularly for fleas? Yes No
Are your pets: Indoor Only Outdoor Only Indoor and Outdoor
Where do your pets sleep at night?
Veterinarian’s (or Vet Hospital) Name:
Have you adopted from a Humane Society or Rescue
Group before? Yes No
If so, how long ago?
Name of Organization:
Have you ever taken an animal to a shelter? Yes No
If yes, why?

 

If you adopt an ARL animal, whould you like male or female?

Treated regularly to prevent fleas? Yes No
Treated by a veterinarian when needed & given
regular vaccines? Yes No
Would s/he be: Indoor Only Outdoor Only Indoor and Outdoor
If outdoors or indoor/outdoor, will there be access to a pet
door and/or sheltered area at all times? Yes No
How many hours/day will the animal be left alone?
Where will the animal be kept when you aren’t home?
What is your definition of disciplining your animal?
Are you prepared to seek necessary training for the animal if
needed? Yes No
Would you allow ARL to deliver the animal to your home? Yes No
Would you allow several home visits, follow-up phone calls after the adoption
so we could see how he/she is doing? Yes No
Are you prepared to provide for this cat/kitten’s physical and financial needs
for his/her lifetime, which will require spending at least $640+ per year on
food, supplies and veterinary care? Yes No