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Please fill out the entire application. An animals is a friend and family member for life. Our goal is to assist potential adopters with the animals best suited to your lifestyle. Inappropriate adoptions can result in unpleasant experiences for both adopters and the pets. Please understand that the animal's welfare is our foremost consideration.
PERSONAL INFORMATION:  
   
Name
Spouse's Name (if appl.)
Address
City, State, Zip
Home Phone
Cell Phone
Work Phone
Email Address
Occupation
Place of Employment
Type of Residence
If other, please explain:
Length of Time at Residence
Own or Rent
If you rent, please provide your Landlord's information Name:

Phone:

Are you planning on moving in the next 12 months?
Have you ever been convicted of a Felony?
If yes, please explain:
   
HOUSEHOLD INFORMATION::  
   
Number of children/step children living at your residence
Age(s) of Children
Number of Adults living at your residence
Who is this pet for?
Do you have a swimming pool?
If yes, what type?
Is there a fence around the pool?
Is there a pool cover?
Is your yard securely enclosed?
What type of fencing do you have?
What is the height of your fence at the lowest point?
What type of shelter do you have for the animal if left outside?
If tethering:  Length of time
If tethering: What type of restraint
Where will the pet be kept during the day?
Where will the pet be kept during the night?
How many hours will your pet be alone in a 24 hour period?
Where will the pet be kept during your absence?
Do you have a Doggie Door?
Does the pet have access to outside when you are not home?

CURRENT AND PREVIOUS PET OWNERSHIP

Do you currently have any pets residing at your residence? 

If yes, please provide the following information:
  Type of Pet
(Dog, Cat, etc)
Breed Gender Age Spayed/Neutered Where kept?
Pet #1
Pet #2
Pet #3
Pet #4

If you currently have more than 4 pets, please use the comment box at the bottom of this application to describe the rest of them.

Have you owned pets in the past

If Yes, please provide the following information:

  Type of Pet
(Dog, Cat, etc)
Breed Gender Age Spayed/Neutered What happened to this Pet?
Pet #1
Pet #2
Pet #3
Pet #4
 
If you have had more than 4 pets in the past, please use the comment box at the bottom of this application to describe the rest of them.

Do you travel often?
If Yes, where will the pet stay while you are gone?
What will happen to your pet if your employment requires frequent transfers?
   
VETERINARIAN INFORMATION  
Do you currently have a vet?
If yes, please provide us with the following information:
Clinic / Vet Name:
Address:
City, State, Zip:
Phone Number:
   
PERSONAL REFERENCES  
Please provide 3 personal references of people not living at your residence:
Reference #1
Name:
Phone:
How does this person know you?

Reference #2
Name:
Phone:
How does this person know you?

Reference #3
Name:
Phone:
How does this person know you?

   
What pet are you applying for?
If not a specific pet, then what is your interest?
Type:
Gender:
Plan to declaw?
 
   
How did you hear about "Those Left Behind" Foundation?
Would you like to be added to our email mailing list?
   
Additional information or comments:
 

To Validate Human entry of this form, please answer the following question:

Is the picture below a dog, cat, or fish?

 

By submitting this application online, I acknowledge that I understand the above questions, and I authorize the investigation of all statements contained in this application.  I understand misrepresenting myself or any statement is fraud and will omit this application.  I understand that Those Left Behind Foundation will do a full screening of my home prior to placement of any animal, if necessary.  I understand that my veterinarian will be contacted and references checked.  This application in no way guarantees placement of an animal and my application cam be rejected for any reason.  Those Left Behind Foundation does not discriminate based on race, religion, age, or creed.