<p> Old Lyme Animal Control ADOPTION APPLICATION</p><p>Date ______Circle One: Feline or Canine</p><p>Name of Pet you are interested in ______</p><p>Name: ______Address: ______City______State______Zip Code______Phone______Email______Date of Birth: ______</p><p>Housing: Do you Own _____ Rent _____? How many years at address: ______Landlord’s Name______Phone______</p><p>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_____?</p><p>Name of Veterinarian______Phone______</p><p>Why are you interested in adopting this animal? ______Have you adopted from a shelter/rescue organization before? Yes_____ No_____ Name of organization ______</p><p>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_____</p><p>This pet must be spayed/neutered with the voucher provided unless already done. Do you agree to this? Yes_____ No_____</p><p>Pets can live ten to twenty years. Are you prepared to assume the responsibility of caring for this pet for its lifetime? Yes_____ No_____</p><p>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_____</p><p>Please provide one person not living with you as a reference: Name: ______Phone: ______</p><p>Additional Comments: ______</p><p>Signature______Date______</p><p>Office Use only</p><p>Adoption approved? Yes_____ No_____ Reason not approved: ______</p><p>Signature______Date______</p>