Name
*
First Name
Last Name
Age
*
Best phone # to reach you
*
(###)
###
####
Email
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Type of animal of interest
*
Canine
Feline
Name of animal
*
How did you hear about us?
*
Where did you see the pet?
*
Pet Finder
Adoption Event
Facebook
Instagram
Other
Your household activity level is:
*
Not active at all
A bit active
Somewhat active
Pretty active
Extremely active
If you suddenly had to give up your pet, what would you do?
*
What will you do with your pets while on vacation?
*
If your new pet becomes seriously ill or injured and requires expensive veterinary care, what will you do?
*
What will you do if the pet doesn't get along with any other animals in the household?
*
What pet behaviors CAN you deal with?
*
What pet behaviors can you NOT deal with?
*
Are you ready to make a lifetime commitment to this pet for its entire life which could be upwards of 20 years?
*
Have you ever surrendered a pet to a rescue or shelter? If so, explain.
*
Have you or anyone in your household and family ever been convicted of animal cruelty or crimes against animals? If so, explain.
*
How many hours will your new pet be left home alone?
*
Where will your new pet be kept while alone in the household?
*
Primary responsible person?
*
Are you willing to spay/neuter the pet?
*
Yes
No
Where will your new pet be kept during the day?
*
Where will your new pet be kept at night
*
If your new pet is a cat/kitten the pet will be:
Indoor only
Indoor and outdoor
Have you ever had a cat declawed?
*
Yes
No
Are there any cats in the household with FELV/FIV?
*
Yes
No
Does anyone in the household have pet allergies? If yes, describe.
*
Please enter all names, ages, and relationships of people in your household.
*
Ex: Jane Doe, 37, Mom
Name and Relationship for Reference 1
*
Phone # for Reference 1
*
(###)
###
####
Name and Relationship for Reference 2
*
Phone # for Reference 2
*
(###)
###
####
Provide the following for all past/current dogs
*
Name, age, sex, spay/neuter status, how long you owned, what happened to this pet
Provide the following for all past/current cats
*
Name, age, sex, spay/neuter status, how long you owned, what happened to this pet
A home check is required before any adoption is finalized. Do you have any objection to a representative of Journey Home coming to visit your home? Please list your concerns.
*
Please describe any other information that may be pertinent to our review of your application.
By clicking below, I certify that the information I have provided is true and that any misrepresentation of facts may result in my losing adoption privileges with Journey Home and my being placed on a "Do Not Adopt To" list.
*
I Certify