Name of animal you're interested in:

Personal Information

Date of Birth:

Email

Occupation

Spouse's Occupation

Please list the names, ages, and relationships of each person currently living in your home (ex: Joe, Dad, 57):

General Housing Information

Other:

If so, how much?

What is the name of your property owner/agent?

Contact name and phone number:

If gift - for whom?

I have another reason for wanting to adopt an animal:

Where will your new pet sleep at night?

In what areas of the home will the pet be allowed?

Explain:

In what areas of the home will the pet be allowed?

Where do your pets stay when you travel?

Explain:

Past/Present Pet History

Please list the name, type, age, gender, and if the pet is spayed or neutered of all current animals (ex: Duke, yellow lab, 1.5 years old, male, neutered):

Please list the name, type, age, gender, and if the pet is spayed or neutered of all animals you no longer have and what happened to that animal (ex: Rosie, Lab mix, spayed female, died of old age):

If not, why?

Date of last vaccination:

How often do you think a pet should go to the vet for routine care?

Name of current/last veterinarian:

Other:

What would you do with your pet if you could no longer keep it for any of the reasons stated above?

Other:

What solutions would you use for the traits listed above or potty accidents?

If yes, why?

Please Provide two personal references:

Reference #1 Name:

Reference #1 Relationship:

Reference #1 Phone Number:

Reference #2 Name:

Reference #2 Relationship:

Reference #2 Phone Number

How did you hear about The Babinski Foundation?

Is there anything else you would like to tell us that you think would be important when considering your application?

Please read and sign below: Many factors determine which applicant will be matched with a particular pet. If you are not able to adopt a pet today, it does not mean that you are not considered a good pet owner or that your home is not acceptable. Our goal is to place all animals into homes that will best suit their individual needs. Please ask for clarification if you have any questions.

Signature:

If we do not email or call you within 7 days of recieving your application, it means either that the pet was adopted by a previous applicant or we felt the situation presented on the application was not the right situation for that particular pet.

Thank you,

The Babinski Foundation Animal Shelter

Adoption Application

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