Companion Connection

Adoption Application

Print, complete/scan and Email form to

"The greatness of a nation and its moral progress can be judged by the way its animals are treated...

I hold that, the more helpless a creature, the more entitled it is to protection by man from the cruelty of man." -Mahatma Gandhi-

APPLICATION TO ADOPT:                                              

                                                                                              COMPANION ANIMAL’S NAME

REASON FOR ADOPTING:                                                                                                                            





City, State, Zip:


Phone Numbers:  Home:




ID No (DL#):



r Own   r Rent

If Renting, are pets allowed?  r Yes   r No



If Yes, provide Landlord’s Name and Phone Number or Written Consent





MEMBERS OF HOUSEHOLD (include yourself)
   PERSON NAME                           RELATIONSHIP                                AGE                 ALLERGY TO ANIMALS?




 r Yes   r No




 r Yes   r No




   r Yes   r No




   rYes   r No



TYPE (Species)        NAME                       GENDER              FIXED(S/N)?         AGE       SHOTS CURRENT?

 r Dog   r Cat


 r Male   r Female

 r Yes  r  No


 r Yes   r No

 r Dog   r Cat


 r Male   r Female

 r Yes   r No


 r Yes   r No

 r Dog   r Cat


 r Male   r Female

 r Yes   r No


 r Yes   r No

 r Dog   rCat


 r Male   r Female

 r Yes  r No


 r Yes   r No



1.  If your pet(s) are not fixed, why?


2.  If your pet(s) are not current on shots, why?


3.  If you go on vacation, what will you do with this adopted companion animal?


4.  Will this adopted pet live mostly indoors or outdoors?

 r Indoors   r Outdoors   r Both   rDog/Cat Door?

5.  If adopting a dog, is your yard fenced?   r Yes r  No

If not, what arrangements will you make for exercise?


6.  How many hours per day will this pet be left alone?


7.  If adopting a cat, are you thinking of declawing? r Yes r No




Personal (non related) Name:

Telephone #:

Veterinarian Name: (If no vet, please give second personal reference)


Telephone #:

I certify that I am 18 years of age or older, and the above information is true and accurate to the best of my knowledge. And I am

willing and able to provide the time and money necessary to medically treat, train and care for a pet.

___________________________________________     ____________________________
                             Signature                                                            Date