First Name*

Last Name*

Address

City

State/Province

Zip/Postal Code
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Email*

Home Phone

Work Phone
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Cell Phone

Alt Email

Text/Pager Email

What is the name or names of the pet(s) are you applying for?

Where Do you live?

Do you own or rent your home?

If you rent, have you received the approval of your landlord to have a pet?

If you rent, please enter your landlord's name and phone number:

Are there other pets in the household?

Please list species, breed, sex and age of all your current pets:

Where do your currents pet(s) sleep?

Will your current pet(s) be accepting of a new pet?

Are your pet(s) spay or neutered?

If your pet(s) are not spay or neutered, please explain:

Are your pets current on their vaccines?

If your pet(s) are not vaccinated, please explain:

How many adults live in your household?

Are the adults in the home aware that you are acquiring a pet?

Are there any children in the household?

Please list the children's ages:

Is anyone in the household allergic to animals?

Please explain any allergies:

Is your yard fenced?
Choose all that apply: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

What is the height of the fence?

Do you have a pool?

Is your pool fenced?

If your pool is not fenced, how will you limit your pet's access to the pool?

Are you willing to have a Mending Fences' representative visit your home?

What kind of pets have you had in the past?

What happened to the pets you no longer have?

Have you ever had to have a pet euthanized?

If you have ever had a pet euthanized, please explain:

Have you ever surrendered a pet to the shelter?

If you have surrendered a pet to a shelter, please explain:

Do you have a veterinarian?

Please list the name & phone number for your veterinarian?

Do you have a groomer?

Please list the name & phone number for your groomer:

Which type of pet are you looking to adopt?

Please explain what are you looking for in a pet?

Please describe your household activity level:

Why are you adopting a pet?

How much time will the pet spend alone during the day?

Where will the pet sleep?

Who in your household will be the primary care giver to the pet?

How much do you expect to spend on maintenance for your pet in one year?

When you go out of town, who will care for your pet ?

Are you willing to take responsibility for this pet for up to 15 years or more?

What provisions will you make for this pet should you become unable to care for him or her?

Is there anything else you would like us to know?

Please provide two references? (name and phone number)

By typing my name below, I certify that the information I have given is true. I understand Mending Fences reserves the right to deny my application for any reason. I further authorize Mending Fences to contact my references as listed. Completion of this application does not guarantee adoption of a Mending Fences pet. Applicant must be at least 18 years of age at the time of adoption and have a valid picture ID. *