EARS Adoption Application
Today's Date
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Animal you are interested in adopting
Bean (Dog - D2023048)
Copper (Dog - D2019050)
Finn (Dog - D2023037)
Floyd (Dog - D2022082)
Lettie (Dog - D2023009)
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:
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Companion
Family Pet
Companion for another pet
Working Pet
Other
If you answered "other" above, please explain here:
How did you find out about us?
Petfinder
Internet Search
Family/Friend
Staff/Volunteer
Facebook/Instagram
Other
Applicant's First Name
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Applicant's Last Name
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Date of Birth
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Street Address
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Address 2
City
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State
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Zip Code
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Phone Number (Primary)
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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.
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House
Apartment
Condo
Townhouse
Mobile Home
Farm
Other
If you answered "other" above, please explain here:
Do you own or rent your home?
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Own
Rent
Someone else owns the Home
Someone else rents the Home
How long have you lived at this address?
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Less than one month
1-2 months
3-6 months
6-9 months
9-12 months
1-2 years
3-5 years
6-10 years
10 + years
Landlord Phone Number
If you rent, does your landlord and lease allow pets?
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Yes
No
Unsure
N/A
Including yourself, how many people live in your household?
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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?
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Yes
No
N/A
Does anyone in your household have allergies to dogs/cats?
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Yes
No
Possibly
N/A
Employment Status
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Full-Time
Part-Time
Retired
Work from Home
Stay at Home Parent
Student
Unemployed
Other
If you chose "other" above, please explain:
If you are employed, what is your current occupation?
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Do you own other pets at the current time?
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No
Yes
If yes, please list their names, breeds, and ages.
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Are all of your pets spayed/neutered/fixed?
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Yes
No
N/A
Tell us about the pets you have owned in the last 10 years, and where they are now.
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Are your pets current on their vaccinations?
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Yes
No
NA
Have you ever turned your dog or cat into a shelter?
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No
Yes
If yes, please explain?
Veterinary Clinic/Hospital Name
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Veterinarian's Name
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Veterinarian's Address, City, State, and Zip Code
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Veterinarian's Phone Number
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Under what name is your record at the veterinary office?
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Monthly preventatives (heartworm and flea/tick) are required. Will you keep your pet up-to-date per this requirement?
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No
Yes
On average, how many hours per day will your pet be left alone?
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Will this pet be predominantly living inside, outside, or both?
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Inside
Outside
Both
Please provide a description of this pet's living conditions.
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Dog Applicants. Do you have a completely fenced-in yard? If so, what kind of fence?
Wood
Chain Link
Electric
Plastic
Iron
Other
Other (I do not have a fenced yard)
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?
Yes
No
N/A
Dog Applicants. If yes, when will they be tied/chained up?
Dog Applicants. Where will the animal sleep?
In bed with me
In bed with my child
In a dog / cat bed
In a kennel / crate
Wherever he or she likes
Outside
Other
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?
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No
Yes
Have you ever been convicted of abuse or neglect of a child or animal?
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No
Yes
If yes, please explain:
Will you allow us to perform home checks?
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No
Yes
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.
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Clear