Applicant Name Address

City State Zip Code

Home Phone Work Phone

Cell Phone

Email Address Enter correct email format

1. Are You 21 years of age or older? Yes No

2. What prompted you to come to W.A.R.?

3. Have you adopted from W.A.R. before? Yes No

If Yes, select type of pet adopted (use the ctrl key to select more than one):
N/A Dog Cat Other

4. Do you live in a (only select one):

House Apartment Condo Trailer Other

5. Do you Own Rent

6. Landlord, Apartment or Mobile Home Park Manager's Phone Number:

7. Do you live with Parents Spouse Roommate(s) Alone

8. Ages of children living with you:

9. Are you planning to move in the next 6 months? Yes No

10. Will this animal be able to move with you? Yes No Don't Know

11. What will happen to this pet when you go on vacation or in case of an emergency?

12. I am adopting this animal for Myself Children Gift Other

13. Are there children that visit your home frequently? Yes No

If yes, list ages of children

14. Are any members of your household allergic to cats/dogs? Yes No

If yes, explain:

15. Please list the breed, sex and age of any pets you now own:

16. Do you have a regular veterinarian? Yes No

Clinic Name Town

Primary Veterinarian

17. Please list the breed, sex and age of any pets you've had within the last 5 years and what happened to each animal:

18. Are your current pets spayed/neutered? Yes No

If no, please explain:

19. Where will this animal be kept?

20. Where will this animal be when you are not home?

21. Do you have a fenced yard? Yes No

If no, how will you handle this dog's exercise and toilet duties?

22. Do you let your housecats outside? Yes No Explain:

23. Are you familiar with introducing a new pet to your household? Yes No

Would you like information?

24. What is your opinion of spaying and neutering of companion animals?

25. How do you feel about a follow up call or visit from W.A.R. personnel?

26. Considering cats and dogs have an average life-span of 10, 15, and even 20 years, do you feel you can give this pet a permanent home for it's entire life span?

27. Do you have any questions or comments?

I certify that the above information is true and understand that false information may result in the nullification of this adoption. I authorize W.A.R. to verify information with my veterinarian. W.A.R. reserves the right to refuse any adoption. This application and the information given herein remains the property of W.A.R.

Applicant's Signature (type your full name as your signature)