Ward-Wiseman Animal Haven Animal Adoption Application
Animal Name
*
Animal ID Number
Name of Applicant
*
Name of Spouse/Partner
Address
*
Home Phone
*
Cell Phone
Email
*
Do you:
*
Own your home.
Rent your home.
Do you have a fenced yard?
*
Yes
No
Will your pet live inside your home?
*
Yes
No
Where will the pet be when you leave home for the day?
*
When you leave home for an extended time?
*
Have you ever taken one of your pets to an animal rescue or pound?
*
Yes
No
If yes, please explain the circumstances:
Name of current or recent Pet #1
Breed
Spayed/Neutered?
Rabies Vaccination?
Licensed/Registered?
Feline Leukemia Prevention (if applicable)?
Heartworm Prevention?
Vet visit this year?
Do you still have this pet?
Name of current or recent Pet #2
Breed
Spayed/Neutered?
Rabies Vaccination?
Licensed/Registered?
Feline Leukemia Prevention (if applicable)?
Heartworm Prevention?
Vet visit this year?
Do you still have this pet?
Name of current or recent Pet #3
Breed
Spayed/Neutered?
Rabies Vaccination?
Licensed/Registered?
Feline Leukemia Prevention (if applicable)?
Heartworm Prevention?
Vet visit this year?
Do you still have this pet?
Veterinarians Name
Vet Clinic (Name, Address, Phone)
I certify that the information I have provided is true, and I authorize Ward-Wiseman Animal Haven to contact those I have listed above to confirm my statements. I certify that I am at least 18 years of age as I submit this application and that I have never been convicted of animal cruelty or neglect. I also understand that the fee of $100 for dogs or $75 for catswill be due prior to picking up my animal.
Your Name (Signature)
*
E-mail Address:
*
Date
*
Drivers License #
*
Drivers License State
*
*
Required
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