EARS Adoption Application

Today's Date *

Animal you are interested in adopting

If no specific animal right now, please describe in detail the pet you are looking for.

Please check the main reason you plan to adopt a pet: *

If you answered "other" above, please explain here:

How did you find out about us?

Applicant's First Name *

Applicant's Last Name *

Date of Birth *

Street Address *

Address 2

City *

State *

Zip Code *

Phone Number (Primary) *

Phone Number (Secondary)

Email Address

Co-applicant First Name

Co-applicant Last Name

Co-applicant Date of Birth

Co-applicant Address

Co-applicant Address2

Co-applicant City

Co-applicant State

Co-applicant Zip Code

Co-applicant Phone (Primary)

Co-applicant Phone (Secondary)

Co-applicant Email Address

Please select your current residence type. *

If you answered "other" above, please explain here:

Do you own or rent your home? *

How long have you lived at this address? *

Landlord Phone Number

If you rent, does your landlord and lease allow pets? *

Including yourself, how many people live in your household? *

Please list the ages & relationship of those who live in your home.

Is everyone in your household aware that you are planning to adopt a pet? *

Does anyone in your household have allergies to dogs/cats? *

Employment Status *

If you chose "other" above, please explain:

If you are employed, what is your current occupation? *

Do you own other pets at the current time? *

If yes, please list their names, breeds, and ages. *

Are all of your pets spayed/neutered/fixed? *

Tell us about the pets you have owned in the last 10 years, and where they are now. *

Are your pets current on their vaccinations? *

Have you ever turned your dog or cat into a shelter? *

If yes, please explain?

Veterinary Clinic/Hospital Name *

Veterinarian's Name *

Veterinarian's Address, City, State, and Zip Code *

Veterinarian's Phone Number *

Under what name is your record at the veterinary office? *

Monthly preventatives (heartworm and flea/tick) are required. Will you keep your pet up-to-date per this requirement? *

On average, how many hours per day will your pet be left alone? *

Will this pet be predominantly living inside, outside, or both? *

Please provide a description of this pet's living conditions. *

Dog Applicants. Do you have a completely fenced-in yard? If so, what kind of fence?

Dog Applicants. If you answered "other" above, please explain:

Dog Applicants. If you do not have a fenced yard, how will you let the animal out?

Dog Applicants.. Are there times when the animal will be tied/chained up?

Dog Applicants. If yes, when will they be tied/chained up?

Dog Applicants. Where will the animal sleep?

Dog applicants. If you answered "other" above, please explain:

Will you keep the animal up-to-date on vaccinations, as well as heartworm and flea/tick preventative? *

Have you ever been convicted of abuse or neglect of a child or animal? *

If yes, please explain:

Will you allow us to perform home checks? *

I have read the foregoing and certify that the answers I have given are complete, true and not misleading in any way. I am authorizing you to contact landlords, associations and veterinarians. I am also aware that EARS cannot guarantee the health and temperament of the animal. *