Fill in the Pet Name only if you've come here from petfinder.com

Pet Name

Would you like to adopt a cat or a dog?  Cat    Dog

First Name

Last Name

Home Phone

Address

City

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Zip Code

Employer

Work Phone

E-Mail

Age

Please list in detail the animal you are looking for.

Please list all the memebers in your household, including ages.

Does anyone in your household have allergies?
If yes, please list the type of allergies.

Please list all the pets currently in your household, including breed and age.

Are they all current on vaccines?  Yes    No

Are they all spayed or neutered?  Yes    No

Please list the pets that are no longer in your care and describe what happened to them.

Do you own a home, rent or live with parents?  Own    Rent    Parents

If you rent, list the landlord's
Name
Phone Number

Where will your new pet be kept during the day? Check all that apply:

House	Crate	Yard	Tie-Out/Chain
Garage	Patio	Dog Run	Basement

If you are adopting a cat, do you plan on having your cat declawed?  Yes    No

How many hours a day will your new pet be alone?

How many hours will your new pet be outside? (dogs and cats)

If you are adopting a dog, what type of fence do you have?

Will you allow your dog to ride in the back of a truck?  Yes    No

How do you plan to train your new pet?

How will you exercise your new pet?

Under what circumstances would you give up your animals?

Besides aggression, which behavioral problems are you willing and able to cope with? Check all that apply:

Chewing	Digging	Jumping	Scratching of furniture/carpeting
Play biting	Shyness	Hiding	Barking
Separation Anxiety		Escaping from house/yard
House soiling/litter box problems

Who is your current veterinarian?

Why do you want to adopt this pet? Check all that apply:

Companion for another pet	Child's pet	Hunting
Watch/Guard dog	Mouser/Barn cat

I understand that this application does not reserve this animal nor does it mean I am eligible to adopt from this agency.

I understand that the adoption agents will do their very best to match this animal with my lifestyle and that if the agent deems this adoption as a non-match that it does not exclude me from adopting animals in the future.

I understand that the adoption agent has the right to deny, reject, decline, refuse or postpone any adoption at any time during the interview.

I understand that the information I have given to be true and that any false information will result in termination of this adoption agreement.

As a condition of adopting this animal, I understand that the Coalition For Animals dba No More Homeless Pets in Utah cannot guarantee the health, training, or temperament of the animal(s) I am adopting. I, hereby for myself, heirs, administrators and assigns, fully, irrevocably, and unconditionally release and agree to hold harmless the Utah Coalition for Animals dba No More Homeless Pets in Utah and their individual members from any and all known or unknown, anticipated or unanticipated, suspected or unsuspected and/or fixed, conditional, or contingent actions, causes of actions, charges, suits, debts, demands, claims, contracts, covenants, liens, rights, liabilities, losses, royalties, costs, expenses, including, without limitations, attorney's fees or damages, including but not limited to any medical costs, damages to property, persons, or other pets, of every kind, nature, description, at law or in equity, in connection with or arising from my adopting said animal.

I have read and understand the above agreement.