Online Adoption Form  < Back to Adoption Page
STEP 1: ANIMAL INFORMATION
Type of Animal: Dog Cat Bird Other
Animal Name:
Gender:
Color:
 
STEP 2: YOUR INFORMATION
First Name:
Last Name:
Address:
City:
State:
Zip:
 
Email Address:
Home Phone:
Cell Phone:
 
STEP 3: LIVING CONDITIONS
Names and number of persons currently living in household (list children and ages):
 
 
Number and types of pets under your care:
 
 

If you have had a pet in the past, please explain what happened to the animal(s):
 
 
In what type of housing do you live?
 
Own Home Rent Home Apartment
 
If you rent, does your landloard allow pets?
 
Yes No
 
Landlord Information:
Name:
Phone:
 
Where pet will be kept:
 
If outside, is your yard fenced?
 
Yes No
 
Where do you plan to keep your pet while you are at work?
 
Where do you plan to keep your pet while on vacation?
 
 
STEP 4: VETERINARY HEALTHCARE INFORMATION
What veterinarian do you plan to take the animal to?
Vet Name:
Vet Phone:
 
STEP 5: REFERENCES
Reference 1:
Name:
Phone:
Email:
 
Reference 2:
Name:
Phone:
Email
 
Add'l comments, questions or suggestions:
 
 
By submitting this form, you understand and agree to the following:
 
  1. Adopting a pet is a life-time commitment.
  2. All of my references will be contacted by APA staff.
  3. By adopting a pet from the APA, I will be subject to periodic checks to ensure proper treatment of the pet.
  4. If I am unable to keep and/or properly care for the pet, I will notify APA.
  5. Upon adopting this pet, I ensure the pet will have proper veterinary care, shelter, diet and treatment.
  6. If I adopt a juvenile dog/cat, I certify the animal will be spayed/neutered by the time the animal reaches 6 months of age.