<p> Josephine County Animal Protection and Regulation 1420 Brookside Blvd, Grants Pass, OR 97526</p><p>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 # </p><p>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.</p><p>Do you live with any children?  YES  NO If Yes, List Their Ages: ______</p><p>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: </p><p>Have you ever had any animal control violations?  YES  NO If Yes, Please Explain: </p><p>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?:______</p><p>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.</p>