Status message *** You must get a confirmation from us it went through. If not it did not go through. Please call preferably at 856 642 -0004 or e mail us at support@animalsanctuarysociety.org that you completed your application with telling us your. name If don’t hear from us in about 24 hours, also call 8566420004 Thank you so much. We don’t want you to miss out on a wonderful adoption. *** About the pet you are interested in Type of pet you are interested in Dog Cat Other… Enter other… Name of pet (if known): Breed Color Age About you Name Title Title - None -MissMsMrMrsDrOther… Enter other… First Last Suffix Address Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Code Phone Type - Type -HomeOfficeCell Phone Ext: Additional Phone Type - Type -HomeOfficeCell Phone Ext: Email Are you 18 years or older Yes No Have you previously adopted from ASSI Yes No Have you previously applied to adopt from ASSI Yes No Place of employment Length of time with this employer years Occupation About your home Do you Own Rent Length of time at this address years Is there a yard Yes No Does the yard have a fence around it Yes No If yes, how high is the fence NA3 or less45678 or more Feet Does your landlord / association permit animals Yes No N/A Name of landlord / association contact Landlord / association phone number Are there children in the home Yes No Children's ages If yes, what type of animals Is anyone in the home allergic to animals Yes No Pet History Do you presently have animals now Yes No If yes, who / what are they Are they kept inside Yes No Have you owned animals in the past Yes No If yes, who / what were they Veterinarian used for your animals Pet owner's name (if different than your name) Vet Address Vet Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Phone number of veterinarian How long have you used this veterinarian years Can we call your veterinarian for a reference Yes No Is there any other shot clinic that you have used Yes No Have you ever had a veterinarian declaw a cat Yes No References References (3 required, 2 if a veterinarian was included above). Include one neighbor. Name Relationship Phone Number Name Relationship Phone Number Name Relationship Phone Number Your New Pet Will you keep your new adopted pet inside Yes No Will your new adopted pet be supervised when outside Yes No Will your new adopted pet be walked on a leash Yes No If your new adopted pet is a cat, will you have it declawed Yes No N/A Are you financially prepared and willing to give your pet the medical care he/she requires, which at a minimum consists of: Immediate veterinarian care in the event of illness or injury Regular shots (rabies and distemper vaccinations), stool specimen checks as per veterinarian instructions If a dog, heartworm checks and kept on heartworm preventative medication as per veterinarian instructions If a cat, AIDS and Leukemia testing and kept up with previous shots I am financially prepared Yes No Availability to meet the pet (days and times)
