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Option 1 - Copy & Paste into E-Mail or attach doc file to e-mail |
Option 2 - Fax Application |
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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
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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
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*** 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)
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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).
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Dog Cat Other: _____________ Breed: _________________________________ Age: __________ Indoor Outdoor Spayed Neutered Vaccinated? ___________________ On heartworm preventative (dog only)? ________ |
Dog Cat Other: _____________ Breed: _________________________________ Age: __________ Indoor Outdoor Spayed Neutered Vaccinated? ___________________ On heartworm preventative (dog only)? ________ |
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Dog Cat Other: _____________ Breed: _________________________________ Age: __________ Indoor Outdoor Spayed Neutered Vaccinated? ___________________ On heartworm preventative (dog only)? ________ |
Dog Cat Other: _____________ Breed: _________________________________ Age: __________ Indoor Outdoor Spayed Neutered Vaccinated? ___________________ 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:
___________________________ |
Spouse’s Employer: __________________________ Hours per day:
___________________________ 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).
_______________________________________________________________________________
For office use only:
Comments:
_______________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Date: ___________________________