Adoption Application


Pet Adoption Network
Phone: 585-338-9175
E-mail at:

Please indicate which pet you are interested in: (required)

Your Name (required)

Street Address (required)

City, State, Zip(required)

How long have you lived at this address:

Home Phone: (required)

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

Your Email (required)

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, please describe below:

How many children do you have?
Boys: Age of boys:
Girls: Age of girls:

Total number of people in household:

Does anyone in the household have allergies?  Yes No
If yes, please describe 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 Indoor/Outdoor
Nights:  Indoors Outdoors Indoor/Outdoor
Additional comments:

Where will your pet sleep?

What is the primary purpose of the pet?
 Companion Guard Mouser Gift Companion for other animal
Additional comments:

Please list all currently owned pets and fill in appropriate boxes:

Type/Breed Age M/F Spayed/Neutered In/Out Declawed

Additional comments:

Have you had pets in the past?  Yes No
If yes, how long and what happened to them?

Have you ever surrendered a pet to a shelter?  Yes No
If yes, why?

Veterinarian Information
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 (required)

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