Pet Pre-Adoption Form – Moline Animal Aid

Requested Pet's Name *

Animal Type *

AAHS ID #

MicroChip # if known

Where did you view the animal?

Personal Information

Are you a student? *

Date of Birth

Adoptor's Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Work History

Retired
Employed
Self Employed

Employer *

Address

Work Phone

Do you rent or own? *

Landlord's Phone

Type of home you live in.

Yard Size For Dog or Puppy *

Is your yard fenced?

Current Pet Owner? *

Animal Type You currenty own? *

How many of each? *

Do you have children in the home? *

If yes, list the ages of children in the home

Please tell us who will care for your pet.

How many hours a day will your pet be aone at home? *

Veterinarian Reference Details

Name *

Email if known

Phone *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Check those that you have read, and understand

You are aware of the leash laws in your community. Keep your dog or puppy on heart worm preventative medicine as prescribed by your Veterinarian
I understand that I'm responsible for, and have the financial means to cover medical expenses for my pet (s)
Cats and Kittens are to be inside and will not be allowed outside without being om a leash.

An Adoption is a legal contract.

If anything should change after the adoption and you can no longer keep your adopted pet, it must be returned to Animal Aid Humane Society. It cannot be given to another shelter or another person.
SPAY/NEUTER POLICY: All adult pets adopted from Animal Aid Humane Society will already be spayed/neutered at the time of adoption. If you wish to adopt a kitten under 5 months of age, we will give you a voucher to have the spay/neuter performed at our cost and at a veterinarian of our choice as soon as the pet reaches 5 months of age.
STATEMENT OF UNDERSTANDING : Will you adhere to this policy? You agree that all statements you have made on this form are true. If it is found that any statements you have made on this form are not true, the adopted animal can be confiscated by Anima Aid Humane Society.. You understand the information and references you have given may be verified by Animal Aid Humane Society to confirm landlord permission, veterinarian references, etc., and that this information will be held in confidence and used only by Animal Aid Humane Society. You also understand that Animal Aid Humane Society maintains the right to refuse any adoptions in the best interest of the animal(s).

Enter any questions you may have. *

Thank you for completing this Pre-Adoption Application Form. The answers that you gave us will help us to determine what type of pet is right for you and your family as well as your lifestyle and will also help us to conclude what type of home you will provide for one or more of our pets. ADOPTION APPROVAL If you have been selected to adopt this pet, someone from Animal Aid Humane Society will contact you by phone or email after receiving and reviewing your Preadoption Application Form. Again we apologize for the length of this pre-adoption form. It is important that we cover all the basic so to speak, so that you and the pet you choose will have a life long lovable relationship. Thank You for understanding

Signature