Old Lyme Animal Control

Old Lyme Animal Control ADOPTION APPLICATION

Date ______Circle One: Feline or Canine

Name of Pet you are interested in ______

Name: ______Address: ______City______State______Zip Code______Phone______Email______Date of Birth: ______

Housing: Do you Own _____ Rent _____? How many years at address: ______Landlord’s Name______Phone______

Do you currently own any animals? Yes_____ No ____ Dogs #_____ Cats #____ Are they spayed or neutered? Yes_____ No_____ Are all vaccinations current? Yes_____ No_____ Will this animal be kept Indoors_____ Outdoors_____ or Both_____?

Name of Veterinarian______Phone______

Why are you interested in adopting this animal? ______Have you adopted from a shelter/rescue organization before? Yes_____ No_____ Name of organization ______

How many pets have you had in the past five years and what happened to them? ______Do you have children living in your home? Yes_____ No_____ Ages of children______A member of our organization may conduct a home visit. Do you agree to this? Yes_____ No_____

This pet must be spayed/neutered with the voucher provided unless already done. Do you agree to this? Yes_____ No_____

Pets can live ten to twenty years. Are you prepared to assume the responsibility of caring for this pet for its lifetime? Yes_____ No_____

If for any reason in the future you are unable to care for this pet you must contact our organization before placing it with any other shelter, organization or rescue group. Do you agree to this? Yes_____ No_____

Please provide one person not living with you as a reference: Name: ______Phone: ______

Additional Comments: ______

Signature______Date______

Office Use only

Adoption approved? Yes_____ No_____ Reason not approved: ______

Signature______Date______