Adoption Application

Animals

About Us

HOW TO HELP

This is our online adoption application. Upon submitting it, one of our staff members will contact you about your adoption plans. To ensure that the animal you want to adopt is best suited to you, your home and your lifestyle, and is placed in an environment compatible with its needs, we would like you to provide the following information. If you rent, we may call your landlord to verify residency and to verify that you can have a pet. Please include the vet's information, including telephone number. We may call them to verify pet information provided and to check on vaccination history. Please also provide a current, working email address as well as current, working telephone numbers. Failure to provide information marked "(REQUIRED)" may result in denial of your application. We reserve the right to refuse adoption to anyone. It is VERY important you fill out all fields. Incomplete information can prevent adoption approval.

Your Name:

Email (REQUIRED):

Telephone (Home):

Telephone (Work):

Telephone (Fax, Cell, or Other):

Address:

City:

State:

ZIP:

Time at this Address (years/months):

Rent or Own:

Rent Own

If you rent, Landlord's Name: (REQUIRED)

Landlord's Number: (REQUIRED)

Please list information for everyone that lives at this address:
	Name	Relationship	Age

Employment	Employer:
	How Long:
	Work Hours/Week

What type of pet do you want to adopt?	Dog	Cat
What type of pet do you want to adopt?	Both

Reason for wanting a pet:

Do you have a preference for breed, gender, age, size, etc? Please specify

List previous pets - IN THE PAST FIVE YEARS:

(Include their breed and what happened to them)

List current pets: Name, Breed, Age, Gender, Spayed or Neutered, primarily inside or outside, and anything that BCHS should know about this pet

	Name	Gender	Kept In/Out	Spayed/Neutered
Pet 1		Male	Inside	Yes
Pet 1	Tell us about this pet	Female	Outside	No
Pet 2		Male	Inside	Yes
Pet 2	Tell us about this pet	Female	Outside	No
Pet 3		Male	Inside	Yes
Pet 3	Tell us about this pet	Female	Outside	No
Pet 4		Male	Inside	Yes
Pet 4	Tell us about this pet	Female	Outside	No

Name, Address, and Phone Number of Current Vet (REQUIRED)

How many hours a day will the pet be left alone?
Where will the pet be during the day?	Inside Free Roaming Inside Crated Outside
Where will the pet be during the night?	Inside Free Roaming Inside Crated Outside
If interested in a dog, do you have a fenced yard?	Yes No	Type	Height	Yard Size
If no fence, how will you confine your dog to your property?
Describe your excercise plan for your pet:
Describe plans for care of your pet while away:
Are you willing to obtain a crate and crate train your dog	Yes No
Are you willing to take your dog to an obedience course?	Yes No
If not, why?
What behaviors would cause you to give up your pet?
Describe the type of pet that would fit best with your family
If there is a particular pet you are interested in adopting, what is its name?