Online Application

Why are you filling out this application?

I would like to meet a pet for POTENTIAL adoption I'm ready to COMMIT to a pet

Name of pet you're interested in:

First Name: Last Name:
Street Address: City:
State: Zip:
Home Phone: Work_Phone: Email:

Note: Please double check your email address for accuracy. We will use this address to reply to you. If you mistype the address, you will not receive our reply. Please, only one email per line.

List all people living in household, include names, ages and relationship to applicant.

Do you own your home?:

Yes No

Type of home currently living in:

House Condo Apartment Mobile Home

Note: Living in an apartment, mobile home or condo WILL NOT disqualify you from adopting a pet as long as you are available to meet that pet's individual needs.

IF RENTING, describe any restrictions or rules on pets:

Number of Years Renting: Make Selection 0 to 1 1 to 2 2 to 3 3 to 4 4 to 5 Over 5 Over 10

Are you currently employed?:

Yes No

IF YES, name employer and years of employment:

Where will pet sleep at night?

Where will pet stay when you are away?

Hours a day left alone: Make Selection 0 to 1 1 to 2 2 to 3 3 to 4 4 to 5 5 to 6 6 to 7 7 to 8 Over 8

How will the dog be let out to relieve itself (Select all that apply)?

Fenced Yard Leash Walk Free Roam Tie Out Cable Kennel Run Loose With Supervision Other

IF OTHER, please explain:

Are familiar with crate training?

Yes No

Do you intend to use a crate?

Yes No

Do you currently have a crate?

Yes No

Will cat be allowed outside?

Yes Never Overnight If it wishes

Please list all pets currently living in your home. Include name, breed, age, and how long you have had them:

Please list all pets you have previously owned. Include name, breed, and why you no longer have them:

Are your current pets fixed?

Yes No

Are your pets current on vaccinations?

Yes No

If you have dogs are they on heartworm prevention?

Yes No

Do you have a veterinarian?

Yes No

Our vet partners: Make Selection Belmont - Great Lakes Hospital for Animals Byron Center - Byron Center Animal Hospital Byron Center - Southkent Veterinary Hospital Caledonia - Southkent Veterinary Hospital Caledonia - South Crossing Vet Center Cascade - Family Friends Vet Hospital Cascade - Cascade Animal Hospital Door - Dorr Veterinary Clinic Fremont - Fremont Animal Hospital Fruitport - West Michigan spay/neuter Clinic Grand Haven - Grand Haven Animal Hospital Grand Haven - Prelesnik Animal Hospital Grand Rapids - Plymouth Road Animal Clinic Grand Rapids - Red Barn Veterinary Clinic Grand Rapids - Safe Harbor Animal Hospital Grand Rapids - Schmitt's Animal Hospital Grand Rapids - Westwood Hills Animal Hospital Holland - East Holland Veterinary Clinic Holland - Ottawa Animal Hospital Howard City - Howard City Animal Hospital Hudsonville - Georgetown Animal Hospital Hudsonville - Jelsema Veterinary Clinic Jenison - Chicago Drive Veterinary Clinic Jenison - Animal Hospital Kentwood - C-SNIP Lowell - Animal Hospital of Lowell Rockford - Rockford Animal Hospital Sand Lake - Sand Lake Veterinary Services Shelby - Companion Animal Veterinary Walker - Kelley’s Animal Clinic White Cloud - Animal Wellness Center of White Cloud Wyoming - Animal Medical Center of Wyoming Wyoming - Wyoming Animal Hospital Zeeland - Zeeland Veterinary Hospital

If your vet is not listed in the drop-down list above then please provide the following information about your vet:

Clinic Name: Clinic Phone:
City: State:

If you have any final comments that you would like to make about this application please do so in the space below: