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
Small Companion Animal Adoption Application
Marin Humane Society
| Marin Humane Society Control#
_______________ Small Companion Animal Application Name/Type of Pet ________ |
Type of Pet Desired: Rabbit r Guinea Pigr Hamster r Ratr Mouse r Otherr _______
What is the reason for adopting this pet? Companion for other pet r For the children r Gift r Companionshipr Breeding r Classroom Use r Other r ______________
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 ____________________
Please list animals presently in your household.
Species
Sex Age
How long owned
Where
Kept
_____________ _____ _____ ______________ _________________________
_____________ _____ _____ ______________ _________________________
_____________ _____ _____ ______________ _________________________
Please list animals owned previously in the last 5 years.
Species
Sex Age
How long owned
What
happened to pet?
_____________ _____ _____ ______________ _________________________
_____________ _____ _____ ______________ _________________________
_____________ _____ _____ ______________ _________________________
Have you ever owned the kind of pet you wish to adopt? ____ If yes, how long ago? ________
What happened to the pet? _____________________________________________________
Did the pet ever have offspring? _____ If yes, what did you do with the offspring? ___________
How will you house your pet? Loose in the yard? r Loose in the house r Cage r (Size ______)
Where will your pet be kept? Outside r In Garage r Covered outside area r In house r
Who will be responsible for your pet's care? ________________________________________
Are
you familiar with this pet's needs for:
Food/water ______
Socialization/Excercise ______
Vet Care ______
Do you have a preference for breed, age, sex? _____________________________________
Signature ________________________________________ Date __________________
Comments: ____________________________________________________________
______________________________________________________________________
Pending ________________ Impound Check ______ Approved (Counselors Int.)___
If this pet is intended for classroom use, please answer the following:
Name of your school ______________________________________________________
City ______________________________________
Age/Grade of children ______________ Number of hours the school is open each day ______
Number of children ______________ Number of adults ______________________
Who will be the main guardian (responsible person) of this pet? _____________________
What care arrangements have been made for the pet during:
Weekends? _______________________________
Extended holidays? _________________________
What will happen to the pet at the end of the school year? _________________________
What kind of experience do you have with this type of pet? _____________________________
__________________________________________________________________________
Is this pet going to be part of a teaching unit you are planning? ______ If yes, how so? _______
___________________________________________________________________________
What is your main purpose in adopting this pet? ______________________________________
What will happen to this pet is his/her temperament is not suitable to a classroom setting? _____
__________________________________________________________________________
Courtesy of
171 Bel Marin Keys Blvd.
Novato, CA 94949
(415) 883-4621
(415) 382-1349 fax
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