page break

Please fill in all the information on this form. When you are done, click on the Submit button and Animal Services will receive the information you have provided. You will also receive an email confirmation if you have provided us with your email address.

Personal Information
Your Name:
Address:
City:
State: Zip:
 
Phone Numbers:  
Day:
Evening:
 
Driver's License No: State:
E-Mail Address:

Adoption Information
  1. Pet Type: Dog Cat Other
    Pet Size: Small Medium Large X-Large
    Breed:
  2. Residence: House Apartment Condo
    Other:
  3. I currently: Rent Own
    If You Rent:
    Complex/Landlord's Name
    Phone
  4. Does any member of your household have allergies? Yes No
  5. Do all members of your household want this pet? Yes No
  6. Do you have a regular veterinarian? No.
    Yes, his/her name is:
    The clinic he/she is employed at is:
  7. Is this your first pet? Yes.
    No, I have had these other pets:
    Where are they now?
  8. Who will be responsible for taking care of this pet?
    Age:
  9. Is this pet a gift? No
    Yes, the pet is a gift for:
  10. Do you have a fenced yard? Yes No
  11. Do you want to keep this pet? Indoors Outside Both
  12. Check all of the following which describe your reasons for wanting to adopt this animal:
    Breeding Child Responsibility Training Companion
    Search and Rescue Guard Dog Household Pet Hunting
    Mouser Show
  13. How many hours will this pet be alone each day?
    Where will the pet spend this time?

Please answer all of the following questions in detail:

  1. What steps will you take to find your pet if it becomes lost?
  2. What will you do with the pet when you go on vacation?
  3. What will you do if your pet becomes ill and needs expensive veterinary care?
  4. What will you do with your pet if you move?
  5. What pets do you have now?
  6. If you have other pets, are their vaccinations current? Yes No
  7. If you have other pets, are they spayed or neutered? Yes No
  8. Are your pets currently licensed? Yes No
  9. How did you first learn about Collier County Domestic Animal Services?
    Newspaper Phone Book Internet Friend
    Veterinarian Web Surfing Driving By
    Other Animal Care Agency
    Other:

Please type what you see:

 

end of page