Adoption Application

Main reason for wanting dog/cat

Temperament Preferred: (check all that apply) Quiet Active Assertive Shy Lap Dog Playful
Gentle Independent Other

Are you or any member of the household allergic to animals?

Your name: Email:

Name of spouse/significant other/roommate:

Street Address:

City: State: Zip:

Home Phone: Work Phone: Best Time to Call

Personal Information:

Are you 21 years of age or older?

Do you:

Own:

Rent:

Live with:

Landlord's name: Phone Number:

Does landlord allow dogs/cats?

Are there any restrictions? If yes, explain:

Will the animal be left alone at home for work/etc? How long? Where?

What will you do with dog/cat if/when you move?

How many people reside in the home?

What are their ages?

What pets do you have living with you now, how many and what breeds?

Please provide the name, address and phone number of the Veterinarian you will be using:

Name:

Street Address: State: Zip Code:

Phone Number:

*NOTICE* For client privacy, many Veterinary offices will not release personal information. For this reason, you will need to call your Veterinarian and inform them that Bellwether Harbor will be calling, to inquire about Veterinary care received for current and past pets you have owned. If we are unable to access this information your application can not be processed.

I certify that all the information in this application is true and correct to the best of my knowledge and belief. I understand that any false information I supply may void the application.