Name of animal(s) in which you are interested:

Your Name
Address
City		State & ZipCode
Home Phone		Work Phone
E-mail*

*Email address is for Snowflake use only and will not be shared.

1. What kind of companion animal are you looking for?

Cat Kitten Dog Puppy

2. Please list a vet reference.

Veterinary Hospital name:
Telephone number:

If you do not have a vet reference, please list a personal reference (including telephone number):

(Note: You are giving us permission to contact a reference listed above)

3. Will your pet's lifestyle be:

Outdoor Indoor/Outdoor Mostly indoor Indoor only

4. Why do you want to adopt a companion animal?

5. How long have you thought about getting a companion animal?

6. List all of the companion animals you have had as an adult (beginning with most current):

Name:	Cat/Dog?	Spayed/Neutered?	Indoor/Outdoor/Both?	Shots Current?	Where is pet now?
	Cat Dog	Yes No	Indoor Outdoor Both	Yes No
	Cat Dog	Yes No	Indoor Outdoor Both	Yes No
	Cat Dog	Yes No	Indoor Outdoor Both	Yes No
	Cat Dog	Yes No	Indoor Outdoor Both	Yes No
	Cat Dog	Yes No	Indoor Outdoor Both	Yes No

List other pets if more space needed:

7. When and in what way will your companion be allowed outdoors? (Check all that apply)

Never	On a leash	On a deck or patio
Out during day/In at night	On a screened porch	When he/she wants to go out
When I am home	Under my supervision	In a fenced yard

8. Please list all household members, listing yourself first:

Name	Age	Agree to have pet?	Allergic to Dogs or Cats?
		Yes No	Dogs Cats None
		Yes No	Dogs Cats None
		Yes No	Dogs Cats None
		Yes No	Dogs Cats None
		Yes No	Dogs Cats None
		Yes No	Dogs Cats None

9. What steps would you take to protect both child and pet when children are in your household?

10. Do you plan to declaw your cat or kitten? Yes No

If yes, please provide your reasons for this decision:

11. Do you own or rent your home? Own Rent

12. If you rent:

Does the owner permit the number of pets you will have?	Yes No
What is your pet deposit?
May we contact your landlord?	Yes No
Name of apartment complex:
Landlord's name and telephone number:

13. What would you do if your current or future rental or apartment did not allow pets?

14. Does your home/apartment have a balcony? Yes No

If yes, on what floor(s)?

15. Do you have a fenced yard? Yes No

16. Are you:

Employed full-time Student Retired Other

17. Do you plan to move in the next 12 months?

18. How long have you lived in this area?

19. Where will your new companion sleep?

20. If you have to move from your current residence, what provisions will you make for your cat or dog?

Take with me	Depends on whether place accepts animals	Give to relative or friend
Put animal in safe place during move	Return to Snowflake
Other - specify:

21. Do you have a pet door? Yes No

22. How do you plan to discipline or train your cat or dog?

23. Who will have primary responsibility for the daily care of this animal?

24.Under what circumstances would you give up your companion?

Allergies	Moving	New Baby	New roommates
New pet	Behavioral problems	Medical problems	Biting
Scratching	Not using litterbox	Too time consuming	Marital status changes
Shedding	Chewing	Children lost interest	None of the above

Other reasons

25. Well-cared for companion animals may live in excess of 15 years.
Do your lifestyle, career and family plans allow you to make this kind of commitment?     Yes No

26. If your companion should develop special needs in the future, what level of care and attention is your household comfortable taking on?

Pilling daily	Daily eyedrops	Special dietary food	Litterbox use problems
Shyness	Heart problems	Diabetes or other complex care	None

27. Your new pet will cost a minimum of $200 per year for veterinary care, food and expenses.
This does not include the cost of any possible injuries or emergencies.

Who will assume financial responsibility for this animal?

Your companion may develop minor to major health problems throughout his/her life. What is a comfortable annual dollar amount for your household to spend on Vet bills?

$200 $500 $1000 Whatever it takes

Note: Pet Health care insurance can be an option to make vet bills more predictable and affordable.

28. How did you find out about Snowflake Animal Rescue?

Classified ad	Newspaper article	Friend or relative
Veterinarian	Snowflake website	Link from other website
Brochure	Radio/TV	Other

30. Do you wish to be contacted about future events? Yes No

Special contact or other information you would like to add?

You must be 18 years or older to sign a legal document such as an adoption contract:
By submitting this adoption application, you certify that you are 18 years or older and can provide state or federally issued identification (such as a driver's license or passport) to verify your age.