Adoption Application


E-Mail Address:
Date of Birth:
How long have you lived at this address?
Do You?
Is your home?
Previous Address if less than 2 years at current address
How Long?
* If renting we must have written consent from your landlord-allowing pets.*
Landlord Name:
Your current place of employment:
Your current work phone:
Do you (or spouse/parents) work for a company that requires frequent moves:
If yes, please explain what will happen to this pet when you move:
Do you have a spouse:
If yes name of spouse:
Spouse's Employment:
Spouse's current work phone:
Do you have children?
If yes, how many children?
If yes what is age of children?
Others in the household:
How do the other household members feel about having a pet?
Does anyone object?
Does anyone have allergies?
Who will have the major responsibility for this pet?
The reason(s) you wish to adopt a pet: (mark all that apply)

OTHER PETS in Household?
Pet 1
Breed and Name:
Pet 2
Breed and Name:
Pet 3
Breed and Name:
Have you adopted from us before?
If so, when?
What happened to the pet?
If you do not currently have a pet, have you ever owned pets in the past?
If yes, what happened to your last pet?
Veterinarian's Name:
Do you have a current record with this Vet?
Date of last visit
Do you understand and agree to provide necessary veterinary care for this animal?
FOR DOGS: Rabies/Distemper/Parvo vaccinations and annual heart worm checks and use of preventative?
FOR CATS: Rabies/Distemper/Feline Leukemia vaccination?
AND provide any care, routine or emergency that is recommended by your Vet?
Is this to be an inside or outside pet?
If outside during the summer, what type of shelter will you provide (be specific):
If outside during the winter months, what type of shelter will you provide (be specific):
Are you aware of the risks involved if a dog is both inside and outside during any weather other than moderate?
Where will this pet spend its time during the days?
Where will this pet spend its time Evenings?
What is the maximum length of time your pet will be left alone?
How often?
Is there an adult home during the day?
During the evening?
FOR DOGS: Is your yard completely fenced?
Type of fence?
How high?
If you do not have a fence, how do you plan to exercise your new dog?
How often will you be able to do this?
I/We plan to have this pet for what length of time?
Where will your new pet sleep?
How did you find out about Animal Lifeline of Iowa?
What type/brand of pet food do you plan to use?
What items other then pet food, do you plan to have for your new pet?
If your new pet were a breed that may be a candidate for cosmetic surgery, would you have it done?
If so, please check the items that apply:

Do you feel you can afford the cost of maintaining your pet, both now and for their lifetime (15+ years)?
What provisions have you made for the introduction of this new family member into your home?
Do you understand that there may be some adjustment problems, at first, which may require training and additional attention?
Are you able and willing to work with this pet in this regard?
Will you agree to contact Animal Lifeline of Iowa, Inc. and return the pet if you can no longer keep this pet for any reason?
Do you understand that you are not allowed to sell or give this pet to anyone?
Please list two references, other than relatives.
Reference 1 Name:
Phone Number:
Reference 2 Name:
Phone Number:
Do you understand that references will be checked?
Do you understand and agree to allow Animal Lifeline of Iowa, Inc. to conduct a pre-adoption home visit and post-adoption home visit, should they deem it necessary?
I give Animal Lifeline of Iowa, Inc. permission to verify any and all information given by me on this application. I understand that any false information given will disqualify my application to adopt.
Applicant Digital Signature:
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