Reservation Form

Location*
Client Information
Pet Owner*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number
Vet Information
Current Vet*
Current Vet Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current Vet Phone Number*
Please enter a valid phone number
I am applying to adopt a pet from this facility identified as follows:
Name*
Approximate Age*
Breed*
Color*
Species*
Sex*
Microchip Number*
We try to match our adoptable pets with the right homes based on temperament, activity level, and other factors. To help us determine if your home is a good fit for Name, please answer the following questions
Do you have other pets?*

YesNo
Please list other pets (name, breed & age)*
Do you have children living in your home or visiting frequently?*

YesNo
Ages of children living in/visiting the home:*
Type of housing: Please select one:*
Do you have a fenced yard?*

YesNo
I agree (please initial each statement):
Initial* To provide proper and adequate food, water, housing, exercise, and grooming for this pet and to treat him/her humanely at all times.
Initial* To provide veterinary care in the form of vaccinations, preventive heartworm medications as appropriate, and such veterinary medical care as is necessary to prevent and/or treat accidents and illnesses.
Initial* To obey local licensing and animal confinement laws.
Initial* Not to sell, give away, or abandon the animal if I no longer desire it but, instead, to return him/her to the above veterinary practice or to a local animal shelter.
Initial* Not to sell, give away, or use this animal for experimental purposes, allow him/her to engage in dog fighting, or pursue any guard dog or attack dog training with him/her.
Initial* That if it is determined that this pet has not been spayed or neutered, I will have him/her spayed or neutered before he/she reaches six months of age if he/she is not an adult.
Initial* That my place of residence in a home, apartment, condominium, townhouse, public housing complex, or other housing complex allows for the ownership and occupancy of the pet I am adopting.
I acknowledge that (initial each statement):
Initial* I have been informed that all animals can carry and transmit diseases, some of which affect people, including bacteria, viruses, parasites, and ringworm, and that these diseases may be undetectable in what appears to be a healthy animal at the time of adoption.
Initial* I am aware that pets may exhibit normal but potentially undesirable behaviors including, but not limited to, aggression, house soiling, biting, scratching (people, furniture, and woodwork), barking, digging, mounting people’s legs, marking with urine (dogs), and spraying urine (cats), and that these normal behavior patterns may be difficult to manage. No one at this facility has told me that this pet will not engage in any of these behavior patterns.
Initial* The above veterinary practice is in no way responsible for any damage the animal may inflict on another person, my property, or the property of another, and no attempt will be made by me to hold the above practice responsible.
Initial* I am aware that, depending on size, species, and/or breed, costs to feed, house, train, license, and provide pet health insurance and/or veterinary care for a pet average between $500 and $1,500 per year. I am financially able to meet and will pay these expenses for my adopted pet.
Initial* I am aware that, depending on size, species, and/or breed, costs to feed, house, train, license, and provide pet health insurance and/or veterinary care for a pet average between $500 and $1,500 per year. I am financially able to meet and will pay these expenses for my adopted pet.
Initial* I have read this agreement and release the above practice from any present or future liability associated with my adoption of this animal.
Printed Name for E-Signature*

First NameLast Name
Date*

MonthDayYear
Are you a robot?*
Should be Empty:

Client Information

Vet Information

I am applying to adopt a pet from this facility identified as follows:

I agree (please initial each statement):

I acknowledge that (initial each statement):