Name
*
First Name
Last Name
Address
Please note: potential adopters should live within 1 hour from Henrico, VA
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Email Address
*
Employer
*
How long at job?
*
Is there a Co-Applicant?
*
Yes
No
If Co-Applicant, please provide additional info.
Co-Applicant Name, Address, Phone Number, Email, Employer, and How long at job?
Is there a specific animal you are interested in?
*
Yes
No
If Yes, please provide name.
If you are interested in a specific animal, are you open to any other animal?
Yes
No
What physical traits are you interested in? (Select all that apply.)
*
Puppy (< 1 yr)
Dog (1-6 yrs)
Senior (7+ yrs)
Male
Female
Small (<25 lbs)
Medium (25-55 lbs)
Large (55-90 lbs)
Giant (90+ lbs)
What personality traits are you interested in? (Select all that apply.)
*
Playful
Obedient
Energetic
Easy Going
Lap Dog
Good w/ Kids
Good w/ Dogs
Good w/ Cats
Companion
Playmate for other pet
Likes to run
Guard Dog
Crate Trained
Housebroken
What behaviors would you find unacceptable, and how would you handle them?
Are you willing to work with a trainer or enroll in classes?
*
Yes
No
If you're adopting a puppy, do you plan to sign up for puppy obedience classes?
Yes
No
Do you have a yard?
*
Yes
No
Why is this a good time for you to adopt a pet?
*
Please tell us about your lifestyle and the type of pet you think would be the perfect match for you and your family.
*
Who will be the primary caretaker of the pet?
*
What would happen to your pet if you had to move?
*
If something were to happen to you, who would take care of your pet(s)?
*
How much money are you prepared to spend for the care of your pet each year?
*
Please provide the number of adults in your household & their ages.
*
Please provide the number of children in your household & their ages.
*
Are all of the adults in the home aware of, and agreeable to, adopting a pet?
*
Yes
No
Do you own or rent?
*
Own
Rent
If you rent, please provide your landlord's name and number.
How long have you been at your current residence?
*
< 1 yr
1-4 yrs
5+ yrs
Who do you live with? (Select all that apply.)
*
Live alone
Spouse
Significant Other
Children
Roommate
Parents
Other
Does anyone in your home have asthma or pet allergies?
*
Yes
No
Who will take care of your pet when you go away overnight?
*
Where will your pet stay when left alone at home?
*
Where will your pet sleep at night?
*
How many hours per day will your pet be alone?
*
<2 hrs
3-6 hrs
7-9 hrs
10+ hrs
How do you plan to exercise your pet?
*
In the past 7 years, have you had pet(s) that are no longer with you?
*
Yes
No
If Yes, please provide additional information.
Kind of pet & what happened to them.
Have you previously adopted a pet through a humane society or animal shelter?
*
Yes
No
If Yes, please provide the name of the society/shelter and the type of pet(s).
Have you ever returned/surrendered a pet to a humane society or animal shelter?
*
Yes
No
If Yes, please provide the name of the society/shelter, the type of pet(s), and the reason for surrender.
Have you ever been reported to animal control or had an animal removed from your care?
*
Yes
No
If Yes, when did this happen, and please explain the circumstances & outcome.
Do you have other pets now?
*
Yes
No
If Yes, please provide additional info about your current pet(s).
For each pet, please provide: type, name, age, sex, spayed/neutered (Y/N), Date of last shots, how long you've had the pet, where the pet stays (inside/outside/both)
Do you have other pets in your home that belong to someone else (relative, roommate, etc)?
*
Yes
No
If Yes, please provide additional info about the pet(s).
For each pet, please provide: type, name, age, sex, spayed/neutered (Y/N), Date of last shots, how long you've lived with the pet, where the pet stays (inside/outside/both)
Current Vet: Name & Number
Previous Vet: Name & Number
Please list three people outside of your home as references.
*
Include name, phone number, and relationship.
Today's Date
*
MM
DD
YYYY
How did you find out about this adoption opportunity?
Facebook
Instagram
Henrico Humane website
3rd party adoption site (Petfinder, Petango, Adopt-a-Pet, etc.)
Friend or family member
Adoption event (Petco)
Other
I live within 1 hour driving distance from Petco Short Pump (11331 W Broad St, Glen Allen, VA 23060).
*
Please validate that you live within 1 hour from Petco Short Pump. We only adopt to people within this radius.
Yes
No