EARS Adoption Application

Today's Date *
Animal you are interested in adopting	Brick (Dog - D2024096) Charlie (Dog - D2023089) Copper (Dog - D2019050) Derby (Dog - D2024058) Fiesty (Cat - C2024036) Floyd (Dog - D2022082) Jack (Dog - D19Y013) Lexi (Dog - D2024070) Maple (Dog - D2024040) Marshmallow (Cat - C2024033) Molly (Dog - D2024078) Ocean (Cat - C2024034) Sami (Dog - D2021041)
If no specific animal right now, please describe in detail the pet you are looking for.
Please check the main reason you plan to adopt a pet: *	Companion Family Pet Companion for another pet Working Pet Other
If you answered "other" above, please explain here:
How did you find out about us?	Petfinder Internet Search Family/Friend Staff/Volunteer Facebook/Instagram Other
Applicant's First Name *
Applicant's Last Name *
Date of Birth *
Street Address *
Address 2
City *
State *
Zip Code *
Phone Number (Primary) * Please use the following format 248-555-1212
Phone Number (Secondary)
Email Address Please enter correctly as this is the main way we will contact you
Co-applicant First Name First name of person who will be living with or sharing responsibilities of caring for the dog.
Co-applicant Last Name Last name of person who will be living with or sharing responsibilities of caring for the dog.
Co-applicant Date of Birth
Co-applicant Address Address of co-applicant
Co-applicant Address2
Co-applicant City
Co-applicant State
Co-applicant Zip Code
Co-applicant Phone (Primary)
Co-applicant Phone (Secondary)
Co-applicant Email Address
Please select your current residence type. *	House Apartment Condo Townhouse Mobile Home Farm Other
If you answered "other" above, please explain here:
Do you own or rent your home? *	Own Rent Someone else owns the Home Someone else rents the Home
How long have you lived at this address? *	Less than one month 1-2 months 3-6 months 6-9 months 9-12 months 1-2 years 3-5 years 6-10 years 10 + years
If you rent, does your landlord and lease allow pets? *	Yes No Unsure N/A
Landlord Phone Number
Including yourself, how many people live in your household? *
Please list the ages & relationship of those who live in your home.
Is everyone in your household aware that you are planning to adopt a pet? *	Yes No N/A
Does anyone in your household have allergies to dogs/cats? *	Yes No Possibly N/A
Employment Status *	Full-Time Part-Time Retired Work from Home Stay at Home Parent Student Unemployed Other
If you chose "other" above, please explain:
If you are employed, what is your current occupation? *
Do you own other pets at the current time? *	NoYes
If yes, please list their names, breeds, and ages. *
Are all of your pets spayed/neutered/fixed? *	Yes No N/A
Tell us about the pets you have owned in the last 10 years, and where they are now. *
Are your pets current on their vaccinations? *	Yes No NA
Have you ever turned your dog or cat into a shelter? *	NoYes
If yes, please explain?
Veterinary Clinic/Hospital Name *
Veterinarian's Name * If you have never owned a pet please tell us where you would go.
Veterinarian's Address, City, State, and Zip Code * Again if you have never owned a pet please list where you would go
Veterinarian's Phone Number *
Under what name is your record at the veterinary office? *
Monthly preventatives (heartworm and flea/tick) are required. Will you keep your pet up-to-date per this requirement? *	NoYes
On average, how many hours per day will your pet be left alone? *
Will this pet be predominantly living inside, outside, or both? *	Inside Outside Both
Please provide a description of this pet's living conditions. *
Dog Applicants. Do you have a completely fenced-in yard? If so, what kind of fence?	Wood Chain Link Electric Plastic Iron Other Other (I do not have a fenced yard)
Dog Applicants. If you answered "other" above, please explain:
Dog Applicants. If you do not have a fenced yard, how will you let the animal out?
Dog Applicants.. Are there times when the animal will be tied/chained up?	Yes No N/A
Dog Applicants. If yes, when will they be tied/chained up?
Dog Applicants. Where will the animal sleep?	In bed with me In bed with my child In a dog / cat bed In a kennel / crate Wherever he or she likes Outside Other
Dog applicants. If you answered "other" above, please explain:
Will you keep the animal up-to-date on vaccinations, as well as heartworm and flea/tick preventative? *	NoYes
Have you ever been convicted of abuse or neglect of a child or animal? *	NoYes
If yes, please explain:
Will you allow us to perform home checks? *	NoYes
I have read the foregoing and certify that the answers I have given are complete, true and not misleading in any way. I am authorizing you to contact landlords, associations and veterinarians. I am also aware that EARS cannot guarantee the health and temperament of the animal. *	Clear