Date: * How did you hear about Bellwether Harbor? * Family or Friend Websites Newsprint, Radio, Facebook PetSmart Retail Store or Other Your Name: * Name of spouse/significant other/roommate: * Address: * City with Zip Code: * State: * Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Please provide contact phone number: * Please provide secondary contact phone number: * Best time to call: * Any Morning Afternoon Evening Email: * Are you over or at least the age of 20? * Yes No Are you or any member of the household allergic to animals? * Yes No If yes, how will/do you control this? * Do you: * Own Rent If you rent you MUST answer the questions below. Where do you live? * House Apartment Condo Mobile Home Room How long have you lived at this address? * If you rent, may we contact the owner to obtain permission for this animal to live in the home? * Yes No Does landlord allow pets? * Yes No Are there any restrictions? * Yes No Landlord's Name: * Landlord's Phone Number: * Must give Landlord's Name AND Phone Numer. Thank you! Do you live with * Spouse Parents/in-laws Roommate(s) Friends Other Family None If other than spouse, please explain: * Are there children in the home? What are their ages? * Do you run a daycare? * Yes No Interested in * Dog Cat Name of Bellwether Harbor dog or cat * Temperament Preferred (select all that apply) * Quiet Active Assertive Companion Gentle Independent Other Describe what type of dog or cat you would like- * What is your main reason for wanting dog or cat? * 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? * 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 currently have, had or will be using: * Whose name are these records listed under and what address? * Adoption Fees $195.... Puppies (less than 6 months old) $175.... Adults (6 months to less than 7 years) $150.... Senior Dogs (7 years and older) $85.... Cats/Kittens (less than 7 years old) $75.... Senior Cats (older than 7 years) *NOTICE* For client privacy, many Veterinary offices will not release personal information. For this reason, YOU 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. * Agree Disagree 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. * Agree Disagree Paragraph Email If you are human, leave this field blank.