Adoption Application
Name of retiree you're interested in:
First and Last Name:
Phone Number:
Email:
Address:
Home Status:
Homeowner
Rent
Other
If you Rent, please list your Landlord's Name & Number:
Is everyone in your household in agreement of adopting and caring for the retiree?
Yes
Do you currently own any other pets?
Yes
No
If yes, please list them below:
Who is your current veterinarian? (Name & Number)
If you do not own a pet, do you have a veterinarian in mind? (Name & Number)
Have you ever surrendered or re-homed an animal? If so, please explain the circumstances:
Have you ever had an animal euthanized? If so, please explain the circumstances:
Verification
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