P.O. Box 700934, Tulsa, OK 74170-0934 Voice: (918) 365-8725 Fax: (918) 587-4422 or ADOPTION QUESTIONNAIRE
Pet Adoption League upholds the belief that pet ownership is a moral, physical and financial responsibility. This questionnaire is designed to help place an animal in its best possible lifelong home. Name___________________________________________________ Date________________________ Address _____________________________________ City/State _______________ Zip _____________ Home Phone ___________________Work Phone ___________________Cell Phone________________ Email Address ______________________________________________________________________ Animal’s name_________________ Breed ________________ Male__Female__ Age _____ PAL# ______ Why do you want a pet? Companion ___ Security___ Sport ___ Breeding ___ For children ___ Gift___ Other reason (explain) _________________________________________________________________ How long have you been actively searching for a pet? (Select one.) #Days___ #Weeks___ #Months___ Where will pet be kept? Indoors ___ Outdoors ___ Indoors/Outdoors ___ On a chain ___ Where will pet sleep at night? __________________________How many hours a day will pet be alone? ____ How much are you willing to spend per year to feed, vaccinate and provide medical care for your pet? $75 ___ $100 ___ $200 ___ Whatever it takes ___ How would you rate your general knowledge of the type of pet you are interested in adopting? Very knowledgeable__________Somewhat knowledgeable____________Little or no knowledge_________ Current veterinarian ______________________________________________ Phone _________________ Please list the pets currently in your household and the veterinarian who cares for them, if different from above: NAME BREED AGE SPAYED/NEUTERED ______________________________________________________________________________________________ ______________________________________________________________________________________________ ______________________________________________________________________________________________ Please list any other pet(s) owned within the past 5 years, and circumstances why they are no longer with you: ___________________________________________________________________________________ ___________________________________________________________________________________ # of adults in family ____ # of children ____ Children’s ages ___________________________________ Is anyone allergic to animals? Yes___ No___ If yes, explain __________________________________________ Do you live in a: House ___ Apartment ___ Mobile home ___ Condo ___ Do you: Own___ Rent___ If renting, what are the pet regulations (security deposits, size and number limitations)?______________________ Landlord name and phone # ______________________________________________________ Describe your home environment: Quiet___ Busy_____ When you travel, who will care for pet? _______________ DOGS ONLY: Will you have time and patience to housebreak the dog, if necessary? Yes____ No_____ What brand of heartworm preventative do you use?__________________ Is your yard fenced? _____ Privacy_______Chain link_______Other_________Height__________ Do you have a swimming pool? _______ If yes, will dog have access to it?________ List two personal references, other than relatives: Name & Phone ________________________________________________________________________ Name & Phone ________________________________________________________________________ Applicant’s Signature ______________________________________________ Date _______________ Office Use checked by___________________________________________Approved?_____________ Interviewed &Only Adoption counselor__________________________Approved________ Notified by____________________________________Remarks________________________________ Notified by____________Date_________Remarks___________________________________________________

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