Sample Shelter Forms
- 1. Cat Adoption Application
- 2. Dog Owner's Questionnaire (Relinquishment Profile)
- 3. Pet/Livestock Adoption Application
- 4. Dog Adoption Application
- 5. Cat Owner's Questionnaire (Relinquishment Profile)
- 6. Adoption Discussion Card - Dog
- 7. Reptile/Amphibian Animal Adoption Application
- 8. Questions to Review by Public Officials and Concerned Citizens
- 9. Adoption Discussion Card - Cat
Pet/Livestock Adoption Application
Marin Humane Society
| Marin Humane Society Control#
_______________ Pet/Livestock Application Name/Type of Pet ________ |
Type of Pet Desired: Sheep r Goat r Horse r Pony r Cow r Otherr __________
Date:_______________________
Your Name _______________________ Driver's License # ____________________
Street/ PO Box_____________________ Home Phone # ______________________
City _______________________ Zip Code ________ Work Phone # _____________
Type of Housing: Rent apartment r Rent House r Own House r Other __________
If you rent, what is your landlord's name? ___________________ Phone # _____________
Number of adults in household: ___ Number of
children in household _______
Children's ages __________
Does anyone have allergies to animals? ____ If yes, what kind of animal allergy? __________
Who is your veterinarian? ____________________________ City __________________
Size of Enclosed Area ______________________ Height of Fence _________________
Type of Fence __________________________________________________________
Type of Shelter _________________________________________________________
Describe Water Set-up ____________________________________________________
Have you ever owned the type of livestock you wish to adopt? ____ If yes, how long ago? ______
Please list livestock owned previously in the last 5
years.
Species
Sex Age
How long owned
What
happened to animal?
_____________ _____ _____ _____________ _______________________
_____________ _____ _____ _____________ _______________________
_____________ _____ _____ _____________ _______________________
Do you own any dogs? _______ Do you have a plan for preventing them from harassing your livestock? _____________________________________________________________
Why do you want this animal? ________________________________________________
What characteristics are important in your selection? _______________________________
_________________________________________________________________________
How will you transport the animal to it's new home? _______________________________
Who will be responsible for your animal's care? ___________________________________
Are
you familiar with this pet's needs for:
Food/water _____
Socialization/exercise _____
Vet Care ______
Do all family members want this type of pet? _____________________________________
Who will care for the animal during your vacation? _________________________________
Signature ________________________________________ Date __________________
Approved for: __________________________________________________________
Comments: ____________________________________________________________
______________________________________________________________________
Pending ________________ Impound Check ______ Approved (Counselors Int.)___
Reason Denied ________________________________________ Date ______________
Courtesy of
171 Bel Marin Keys Blvd.
Novato, CA 94949
(415) 883-4621
(415) 382-1349 fax
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For Shelters: Sample Shelter Forms:
Dog Adoption Application
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