Pet Adoption Application – Coastal Veterinary

Please Read and The Following Terms:

All Pets adopted out have been spayed or neutered, received their core vaccinations, and have been Feline Leukemia and FIV tested. Any non-core vaccines are up to the owner to pursue with their veterinarian. If approved, a non-refundable adoption fee of $150.00* will be required. *If adopting multiple animals, the fee becomes $125.00 per animal.*

I am aware and prepared that a yearly exam, vaccines, and flea/tick/heartworm prevention can cost an average of $400 a year, or more in some cases. Kittens and puppies need vaccines and deworming that can cost an average of $100 a month for the first 4 months in your care.

We consider the adoption of any Pet to be a life-long commitment of time, affection, money, patience, and responsibility.

In order to be considered as an adopter, you must:
● Be at least 18 years of age
● Have a picture ID showing your present address
● Have the knowledge and consent of your landlord as applicable
● Understand that we have the right to verify any information on this application, including property check and a veterinary check
● Have the knowledge and consent of all adults living in your household

Which Pet(s) are you interested in adopting?

Have you given enough thought to this adoption?

Yes
No
Unsure

Is this your first Pet?

Who will care for this Pet?

Does your residence allow Pets?*

Yes
No
Unsure

Personal Information:

Name*

First Last

Spouse/Partner Name:

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone:*

Email:*

Driver’s License:

Current Employer:*

Employer Phone Number:

(1) Please List a character references unrelated to you (include phone number):*

(2) Please List a character references unrelated to you (include phone number):*

Housing

Do you live in a:*

House
Apartment
Townhouse
Other

Do you:*

Own a home
Rent
Live with parents
I am in the process of moving

Landlord’s Name:

Landlord’s Phone Number:

Please list the AGES of ALL children living with you:

Does anyone in your household have animal related allergies?*

Yes
No

Pet Information:

Current Household Pets: Please list all pets currently in your household.*

Please include: Name/Breed, Cat/Dog/Other, Spayed/Neuter, Kept indoors/outdoors, Age.

Past Pets (Last 10 Years): If applicable, list pets you've had in the last decade, including what happened to them (e.g., rehomed, passed away, etc.).*

Are your other pets current on all vaccinations?*

Yes
No
Unsure

Do your dogs/cats get along with other cats?*

Yes
No
Unsure

Do you own any other small animals?

Yes
No

Where will this animal be kept during the day?*

Where will this animal be kept during the night?*

How many hours, on average, will it spend alone during a typical day?

If adopting a cat, will he/she be allowed outdoors?*

Yes
No

If yes, under what conditions?

Do you plan on declawing?*

Yes
No

Pets are an investment of your time and money. Can you afford to provide medical care, grooming, proper diet, proper shelter, and exercise for your new pet?*

Yes
No

If your Pet was injured or ill, are you committed to take him/her to the vet?*

Yes
No

Are you able to make a long term commitment to care for this Pet for it’s entire lifespan, which could be as much as 10-20 years?*

Yes
No

Do you currently have an established Veterinarian?*

Yes
No

If yes, please list Hospital Name:*

Hospital Phone Number:

I certify*

that I have read this questionnaire, and that the information I have given is true and accurate, and I understand that any falsification may result in the nullification of this adoption.

Pet Adoption Application Form

Personal Information:

Housing

Pet Information:

Location

Hours of Operation

After Hours Emergency

Care Credit

Trupanion Pet Insurance

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