Josephine County Animal Protection and Regulation
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Josephine County Animal Protection and Regulation 1420 Brookside Blvd, Grants Pass, OR 97526
ANIMAL ADOPTION APPLICATION Adopter’s name: Date: Street Address: City: ST: Zip: Mailing Address: City: ST: Zip: Home Phone: Cell/Alt: E-Mail: __ Are You 18 Years of Age? YES NO Oregon Drivers License #
Please answer the following questions. No specific answer will qualify or disqualify you from adoption, so please answer honestly so we can ensure the right fit for you.
Do you live with any children? YES NO If Yes, List Their Ages: ______
Type of Residence: Apartment Mobile Home Park Duplex Single family home Do You: Own Rent Lease Location: City County If Renting/Leasing: Landlord/Agent’s Name: Address: City: ST: Zip: Phone: Non-homeowners must provide written approval for pets from landlord or rental agency. Do You Have Any Pets? YES NO If Yes, Select Types (check all that apply) Dog(s) How Many? Cat(s) How Many? Other:______Horse(s) How Many? Livestock How Many? Please List Your Veterinarian or Veterinary Agency:
Have you ever had any animal control violations? YES NO If Yes, Please Explain:
Is this your first pet? YES NO Besides any current pets, what happened to your last pet? Passed Away Re-homed Lost Other N/A Briefly explain the situation:______How would you describe your lifestyle? Very active Moderately active Laid back Quiet & calm What type of pet are you looking for? Social butterfly Adventure partner Playful/active Kid companion Loyal Affectionate/cuddly Protective/watch dog Quiet & calm Lap buddy Laidback/couch potato Does your home have a secure enclosed area? YES NO If yes, how tall is the fence?______If you don’t have a fence, what is your plan for exercise and bathroom breaks? (e.g., walks, daycare, on a lead, etc): ______Is there anything else you think we should know?:______
Josephine County Animal Protection and Regulation maintains full discretion for determining the adopter of our animals. We do not make any holds, reservations, or take deposits on any animals at the shelter.