Pet Adoption Network
Phone: 585-338-9175
E-mail at: Info@PetAdoptionNetwork.org 		Please indicate which pet you are interested in:
Name:
Street Address:
City / State / Zip
How long have you lived at this address:
Home Phone: Answering Machine or Voice Mail?Yes   No
Work Phone: Answering Machine or Voice Mail?Yes   No
Cell Phone: Answering Machine or Voice Mail?Yes   No
Email Address:
How did you hear about Pet Adoption Network?
Applicant Lives In: House   Apartment   Condo   Townhouse   Mobile Home  
Do You Rent? Yes    No
If yes, does your lease allow pets? Yes   No   
A copy of your lease is required.
Landlord's Name:
Landlord's Address:
Landlord's Phone:
Are there any restrictions indicated in your lease? Yes    No   If yes, describe below:
How many children do you have? Boys:    Ages of Boys:
Girls:    Ages of Girls:
Total number of people in household:
Does anyone in the household have allergies? Yes    No   If yes, describe type below:
Are all family members committed to getting a pet? Yes    No   
How many hours will your pet be alone?
Who will be the primary caregiver?
Applicant Is: Employed    Student    Retired    Other   If other, please explain below:
Work Schedule(s):
Where will the pet be kept? Days: Indoors    Outdoors   
Nights: Indoors    Outdoors   

Additional Comments:
Where will your pet sleep?
What is the primary purpose of the pet? Companion    Guard dog    Mouser    Gift for someone    Companion for other animal   

Additional Comments:
Please list all currently owned pets:

Type/Breed Age M/F Spayed/Neutered In/Out Declawed
1
2
3
4
5

Additional Comments:
Have you had pets in the past? Yes    No   
If yes, for how long and what happened to them?
Have you ever surrendered a pet to a shelter? Yes    No   
If yes, why?
For those seeking a dog or puppy: Are you willing to crate train? Yes    No
Are you willing to attend obedience classes? Yes    No
Do you have a fully fenced in yard? Yes    No   
If yes, fence type:
If no, how will the dog be restrained outside? Chain    Runner Line    Walks on leash only    Other
If other, please describe:
Veterinarian Information Name:
Phone:
Name of pet(s) registered with your Vet:
Are your pets current on all vaccines? Yes    No   

Additional Comments:
By completing and submitting this form, I affirm that I am at least 21 years old and that the information I have provided is true and complete. I agree that if I am approved for adoption I will make a commitment of time and money to my animal companion for the rest of its natural life (possibly up to 20 years). I also authorize my veterinarian to release information to Pet Adoption Network concerning my pets.

Click button by Yes to indicate that you agree to these terms. Yes    No