Adoption Application
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Personal Information
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| Name
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| Prefix
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| First
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| Last
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| Suffix
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| Date of Birth
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| Address
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| Street Address
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| Address Line 2
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| City
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| State / Province / Region
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| Postal / Zip Code
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| Country
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| Email
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| Phone Number
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| Employer:
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MORE INFORMATION:
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| Animal Applied For
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| Reason for adopting
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Mouser Companion for other animal Companion for person Gift
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| This animal will be
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Declawed front Declawed, all four paws Not declawed Not sure
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| This animal will be
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Inside Only Outside Only Inside with access to outside
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YOUR RESIDENCE
Providing false information will automatically result in application denial
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| Are you renting your current residence?
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Yes No
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| If so, please prvide the landlord's name, telephone &/or email:
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BASIC QUESTIONS:
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| What would you do if this animal starting urinating inapproriately (e.g., outside the litterpan)?
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| What would you do if this animal scratched someone?
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| If you or your family member became pregnant, what would happen to this animal?
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| How much do you anticipate to spend in ONE YEAR for veterinary care, food, and litter?
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| Provide name, address, and phone of your veterinarian.
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PET OWNERSHIP
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CURRENT ANIMALS
Current Pet #1 Name
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| Current Pet #1 is:
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Dog Cat
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| Current Pet #1 is:
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Female, spayed Female, NOT spayed Male, neutered Male, NOT neutered
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| Current Pet #2 Name
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| Current Pet #2 is:
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Dog Cat
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| Current Pet #2 is:
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Female, spayed Female, NOT spayed Male, neutered Male, NOT neutered
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| Current Pet #3 Name
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| Current Pet #3 is:
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Dog Cat
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| Current Pet #3 is:
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Female, spayed Female, NOT spayed Male, neutered Male, NOT neutered
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PREVIOUS ANIMALS
Previous Pet #1 Name
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| Previous Pet #1 was:
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Dog Cat
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| Previous Pet #1 was:
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Female, spayed Female, NOT spayed Male, neutered Male, NOT neutered
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| Previous Pet #2 Name
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| Previous Pet #2 was:
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Dog Cat
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| Previous Pet #2 was:
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Female, spayed Female, NOT spayed Male, neutered Male, NOT neutered
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I certify that information contained in this application is true and complete. I further authorize the verification of any or all information listed above.
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| Do you agree with the terms and conditions?
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Yes, I agree.
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Electronic signature
By typing your name, you are electronically signing this document.
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| Date
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Image Verification
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