Form cover
Page 1 of 2

Veterinary Medical Charities: Adoption Application

Pet Applying For - Name/Description

Applicant Information

Applicant Name

Additional Applicant Name

Are you over the age of 18 years old?

Are you over the age of 18 years old?
A
B

Current Address

Email

Cell Phone

Employer Name

Title/Position

Employer Address

Name of nearest relative/friend who can be a reference for you

Phone number of nearest relative/friend who can be a reference for you

How many adults live in your home?

How many children (under the age of 18) live in your home?

What are the ages of the children? If none, type "n/a"

Does everyone who lives in your home know that you are applying to adopt a pet?

Is anyone in your home disabled?

Do you rent or own your home?

Does your home a yard?

Do you have any pets currently living in your home?

Please list the type(s)/number/age(s) of the animals in your home

Are they spayed/neutered?

Are your current cats indoor, outdoor, or both?

Are your current cats indoor, outdoor, or both?
A
B
C
D

Are your pets up-to-date on vaccines? *Proof of vaccinations for other pets is required*

Have you adopted animals from Veterinary Medical Charities/Wasatch Hollow Animal Hospital before?

List the names and phone numbers of any veterinarians that you have used in the last 3 years

What other pets have you had and what happened to them?

Have you ever surrendered an animal to a shelter or rescue? If so - please tell us about the situation

How many hours per day will the pet you wish to adopt be left home alone?

Where will this pet be kept at night?

What behaviors will you tolerate?

What behaviors will you NOT tolerate? - Explain how you will handle them

What type of food will you be feeding (Brand, wet, dry, free feed, scheduled meals)

Are you financially capable of taking care of a cat or dog? Please note, as a part of our adoption agreement, you will agree to annual examinations and preventative care, treating health issues, and potential emergencies - which can cost thousands of dollars

If you have to go out of town - who will care for your pet?

Have you ever moved with a pet? If so, what happened to the pet?

How long do you intend to keep your pet?

Who will take care of your pet if something happens to you?

Veterinarian Information Release:

I am authorizing Veterinary Medical Charities to inquire about the health of my current animals as well as any deceased/no longer owned animals on the records under my/our name. I am authorizing the release of vaccination records, clinical records, payment history, and whether or not the animal has visited the clinic in the past 12 months
Veterinarian Information Release:
A
B
Signature

Home Photos

Please upload photos of your home.
Photos requested including the main living area, kitchen, the area the pet will spend the most time in (where litter box, food, water will be kept), bedrooms the pet will be allowed in, front and back yard.