Animal Service League Family Profile Questionnaire

Please complete the following questionnaire, answering ALL questions fully.

Note: Adopting an animal into your home requires a lifetime commitment. Pets are NOT a "disposable" commodity. If you have any doubt about your commitment to this proposed adoption, do not bother to complete this form.
Contact Lois or call 269/782-6352 if you have any questions

First Name

Last Name

Drivers License or State ID Number (please enter both State and Number)

Complete Address (please include street address, city, state and zipcode):

Occupation:

Employer Name and Address (please include street address, city, and state):

Home Phone

Work Phone

Email Address

Age Bracket (please select one) Minor (-18) Adult Senior (65+)

Names and relationships of other adults in household:

Occupation of other adults in household:

Names and ages of children living in household:

Do you have other pets in the household now? Yes No

If Yes, please describe, in DETAIL(names, breeds, ages, spayed or neutered, etc)

Did you have any pets previously that you no longer have?(names, ages, when passed away, etc.)
Yes No

If So, what happened to it/ them?

Do You Own Or Rent: Own Rent
What type of dwelling: House Apartment Condo Duplex Farm Ranch Townhouse Mobile Other

If you rent, please list your landlord's name, phone number and address:

Do you have a fenced yard?
Yes No
If you do have a fenced in yard, which type of fencing? (please select all that apply)
Chain Link Woven Wire Privacy/Stockade Split Rail Picket Electronic/Underground
If you do have a fenced in yard, what height is your fencing?
2' 3' 4' 5' 6'

Do you have a pool? Yes No
Is the pool fenced in? Yes No

Will the pet be inside or outside? Indoors Outdoors
Please describe briefly where the pet will live:

Approximately how many hours per day will the pet be alone?

Does anyone in your household smoke? Yes No
Is smoking allowed inside your home? Yes No

Do you understand that no form of registration is provided with the animal, and that the animal is only to be a family pet?
Yes No

Are you willing to provide medical care, vaccinations/licensing, proper nutrition, training and shelter for the pet as long as the animal is in your care, and to notify ANIMAL SERVICE LEAGUE should circumstances arise which might cause you to have to surrender the animal from your household?
Yes No

Do you or any member of your household suffer from allergies?
Yes No

If so, to what types of allergens?

If you or a member of your household were to show indications of being allergic to the pet you would be adopting, would you seek medical help?
Yes No. Give the dog back? Yes No

Please provide the name, address and phone number of your current or most recent veterinarian(s):

Please provide the names, addresses and phone numbers of a minimum of 2 personal references, including one neighbor (people who know you as a pet owner):

Please describe the type of animal (breed, size, age, name if known) that you hope to adopt:

OUR APPLICATION PROCESSING NORMALLY TAKES FROM 24 HOURS TO 72 HOURS, DEPENDING ON HOW QUICKLY WE CAN REACH YOUR REFERENCES. PLEASE CHECK YOUR E-MAIL DAILY FOR OUR NOTIFICATIONS.

IF YOUR APPLICATION IS APPROVED, WITHIN HOW MANY DAYS FROM NOTIFICATION OF APPROVAL ARE YOU PREPARED TO COMPLETE THE ADOPTION AND TAKE POSSESSION OF YOUR NEW PET?

IF YOU ARE PLANNING A VACATION, OTHER TRIP OR HAVE COMMITMENTS IN THE NEAR FUTURE THAT WOULD DELAY COMPLETION OF THE ADOPTION, PLEASE EXPLAIN BELOW. (A delay of two weeks or more, if mutually agreed upon, will require the submission of a non-refundable deposit of 50% of the adoption fee that will be applied to the full adoption fee when completed).

I certify that the above information is true, and I understand that prior to my acceptance for adoption of an animal from ANIMAL SERVICE LEAGUE the information will be verified. I give permission for my veterinarian to release information related to health care provided to my current and previous pets. In addition, I agree to a home visit and family interview to be conducted by a representative of ANIMAL SERVICE LEAGUE to determine the suitability of my home/facility to care for the animal to be adopted.

Digital Signature (please enter your name here):

Date:

PLEASE REVIEW YOUR ANSWERS TO ALL QUESTIONS, MAKING CERTAIN THAT YOU HAVE PROVIDED ALL INFORMATION REQUESTED. MISSING OR INACCURATE ANSWERS CAN DELAY THE PROCESSING OF YOUR APPLICATION.



 
   

Animal Service League:P.O. Box 185, Dowagiac, MI 49047
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Protect your pet. ShelterCare Pet Insurance Programs
Every time a completed application for a ShelterCare program is generated through our shelter’s website,we automatically receive a $25 donation to help cover common needs like blankets,litter and food.This donation is of no cost to you and provides us with essential funds.

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