JUST ANIMALS SHELTER
ADOPTION APPLICATION FORM

Option 1 - Copy & Paste into E-Mail or attach doc file to e-mail

Option 2 - Fax Application

To fill in the application:

        1st - Highlight the following application and Copy

        2nd - Click on Submit Application

        3rd - Paste application into your e-mail.

        4th - Fill in your answers

        5th - Send the e-mail

 

1st - Open Application in Word 2003 format

2nd - Print Application

3rd - Fill in your answers

4th - Fax to 815-357-6744

JUST ANIMALS SHELTER

"Our No-Kill, Love-Filled Shelter"

2996 26th Road (East Union Street)

P.O. Box 298

Seneca, IL 61360

Phone: 815-357-1223 Fax: 815-357-6744

E-MAIL: adopt@justanimals.org


Incomplete Applications Will Not Be Processed

*** ADOPTION APPLICATION ***

Name:____________________________________________________ Phone (H): ______________________

(First) (Last)

Phone (W): ______________________

Address: __________________________________________________

Phone (Cell): ____________________

_________________________________________________________
(City) (State) (Zip)

E-Mail: _________________________________________

Please Check off the Appropriate Choices throughout this Questionnaire: WE DO NOT ADOPT TO PERSON’S Under 21 (photo I.D. may be requested).

ARE YOU: Married: ______ Single: ______ Roommates: ______

21-40: ______ 41 – 60: ______ 61-80: ______ 81+: ______

 

YOU ARE CONSIDERING ADOPTING (Name of Animal):____________________________________

DOG

Male: ______ Female: ______

Breed Preference: ________________________

______ Adult – (over 1 year old)

______ Adolescent – (4 m-1 year)

______ Puppy – (2-4 months)

 

CAT

Male: ______ Female: ______

Long-Haired: ______ Short-Haired: ______

Color Preference: _________________________

______ Adult – (over 1 year old)

______ Adolescent – (4 m-1 year)

______ Kitten – (2-4 months)
 

Please Answer ALL questions by circling, (on computer - changing to bold) or in detail where indicated.

1.  The reason I want a pet is : ____________________________________________________________
     ____________________________________________________________________________________

2.  Is the pet for your family?                       YES    NO

3.  Does your entire family want a pet?         YES    NO

4.  Is the pet a gift?                                     YES    NO

5.  If yes, Who is the gift for? ____________________________________________________________

6.  Are all family members aware you are adopting a pet?         YES    NO

7.  How many adults in the household? _______

8.  How many children in the household? ____________ What are their ages? _________________

9.  Who has allergies, and to what animals? ____________________

10.  Whose Responsibility is the care of this pet? ______________________________________________

11.  Vet costs can add up. The average sick call to a vet is around $250.00? How much would you be willing and able to pay
       a vet should your pet become ill? ___________________________________

12. My pet will be kept in:
         House     Garage     Basement     Outdoors     Outdoor     Kennel     Tied Out     Crate

13. Will your pet be crate trained (dogs only)? YES NO

14. Will you attend Obedience Classes (dogs only)? YES NO

15. Are you prepared for chewing, digging, scratching, house training/litterbox accidents, and other
      mischievous behavior? YES NO

16. How will you reprimand your pet? ________________________________________________
      _____________________________________________________________________________

17. It may take your new pet a month (or longer if other pets are involved) to adjust to its new home.
      How will you handle this? _________________________________________________________
      ________________________________________________________________________________
      ________________________________________________________________________________

18. How did you hear about us? ________________________________________________________

19. Have you applied for, or adopted a pet from us or any other shelter before? YES NO

Where?: ______________________ When?: ___________________ Name of Pet: ______________

_____________________________________________________________________________

20. Do you: RENT or OWN
          House     Townhouse     Condo     Apartment     Mobile     Home     Live with Parents

21. If you own, do you have a fenced in yard (dogs only)? YES NO

22. If renting, are pets allowed? YES NO
      Deposit Required? YES NO
      Weight Limit? __________ Lbs.

        Name of Complex: _____________________________________________________________
        City and State of Complex: _______________________________________________________
        Name of Landlord: _____________________________________________________________
        Landlord’s Phone Number: _______________________________________________________

23. If you move where pets are not allowed, what will you do with your pets? _______________________

_____________________________________________________________________________

Animals presently living in the house (Circle or Bold choices / Fill in Blanks).

Dog Cat Other: _____________

Breed: _________________________________

Age: __________

Indoor Outdoor
Male Female

Spayed Neutered

Vaccinated? ___________________
Declawed (cat only) ________________

On heartworm preventative (dog only)? ________

 

Dog Cat Other: _____________

Breed: _________________________________

Age: __________

Indoor Outdoor
Male Female

Spayed Neutered

Vaccinated? ___________________
Declawed (cat only) ________________

On heartworm preventative (dog only)? ________

 

Dog Cat Other: _____________

Breed: _________________________________

Age: __________

Indoor Outdoor
Male Female

Spayed Neutered

Vaccinated? ___________________
Declawed (cat only) ________________

On heartworm preventative (dog only)? ________

 

Dog Cat Other: _____________

Breed: _________________________________

Age: __________

Indoor Outdoor
Male Female

Spayed Neutered

Vaccinated? ___________________
Declawed (cat only) ________________

On heartworm preventative (dog only)? ________

25. Other than the animals listed above, please indicate additional pets you have owned in the last 5 years. ___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________

                    Were any lost? ______ Hit by a car? ______ Put to sleep? ______

                    Why? ________________________________________________________________

Were any given away? ______________________ To Whom? ________________________

        Why? _______________________________________________________________

26. Who is your Vet, and where is s/he located? _____________________________________________

                                                                        _____________________________________________

                                                                        _____________________________________________

Vet Phone #: ____________________________________________

27. Is this your first pet? ___________________
 


Employer’s Name: ___________________________

Hours per day: ___________________________
Position: ________________________________


Spouse’s Employer: __________________________

Hours per day: ___________________________
Position: ________________________________

Phone Number: ___________________________

28. REFERENCES (non-family please):

               NAME:____________________________________________ RELATIONSHIP:____________________

               PHONE:___________________________ EMAIL:___________________________________________


           NAME:____________________________________________ RELATIONSHIP:____________________

           PHONE:___________________________ EMAIL:___________________________________________

__________________________________________________________________________________________________________________________________

THE INFORMATION ON THIS QUESTIONNAIRE WILL BE KEPT CONFIDENTIAL.

I CERTIFY THAT THE INFORMATION PROVIDED IS COMPLETE AND CORRECT TO THE BEST OF MY KNOWLEDGE. I ALSO CERTIFY THAT JUST ANIMAL’S SHELTER HAS MY PERMISSION TO CONTACT ANY AND ALL OF MY LISTED REFERENCES AS WELL AS MY VETRENARIAN(S).

_______________________________________________________________________________
(Signature)                                                                                                                                     (Date)


For office use only:

Comments: _______________________________________________________________________________
_________________________________________________________________________________________
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Date: ___________________________


  

TO E-MAIL APPLICATION