Adoption Preferences
Which cat/rabbit are you interested in adopting
How did you become aware of this pet?
Why do you want to adopt this particular cat/rabbit
What special needs have you been told will be needed for this cat/rabbit?
I am adopting
Family pet
Child's companion
Gift
Companion for self
Breeding
Companion for my pet
Applicant Information
First & last name
Address
City
State
Zipcode
Length of time at address
Date of birth
Driver's license number?
Email
Preferred phone number
Occupation
Hours worked each week
Employer's name
Years employed there
Employer address & telephone number
Please list 2 references you have known for at least 5 years who are not members of your immediate family. Include name, phone number, relationship and how long you have known them.
Have you owned cats/rabbits or currently own cats/rabbits
Yes
No
Do you have any health conditions which could restrict your ability to care for a cat/rabbit
In the past, have you applied to adopt from another rescue group or shelter
Yes
No
If yes, name of organization/shelter:
Did you adopt?
Yes
No
If no, why not?
Spouse or Partners Information
Do you have a spouse or partner?
Yes
No
Spouse's/partner's name
Spouse's/partner's date of birth
Spouse/partner's driver's license number
Spouse's/partner's email address?
Spouse's/partner's preferred phone
Spouse's/partners occupation
Spouse's/partner's employer
Hours worked each week
Years employed there
Spouse's/partner's employer address & telephone number
Home Environment
Individiuals who share your home (names, ages & relationship)
Are there regular visitors to your home (human or animal) which your new cat/rabbit must get along with
Yes
No
List any minors who live with you and their ages
Living arrangements
House
Apartment
Condo
Mobile home
Do you own or rent?
Own
Rent
Can you provide proof of ownership
Yes
No
Length of time renting
Landlord name
Landlord phone number
Do you have written permission to have the cat/rabbit you want to adopt?
Yes
No
What are your plans for your cat/rabbit if you move locally:
Out of state
Out of the country
If you choose to move to a place where pets are not allowed, what would happen to the cat/rabbit?
Do you have a doggie door
Yes
No
Where is the doggie door
When is the doggie door left open
Do all doors that exit your home have screen doors?
Yes
No
If not, please list the ones that do not.
Do you have a backyard or patio?
Backyard
Patio
Neither
Is your backyard or patio completely fenced
Yes
No
Fence type:
Block
Chain link
Wooden
Rod iron
Vinyl
Lowest height of fence
Does the backyard or patio have a gate?
Yes
No
How is the gate secured
Latch
Keyed lock
Deadbolt
Padlock
Lowest height of gate
I do not lock the gate because:
Is your yard space shared with other tenants
Yes
No
Do you have a pool, Jacuzzi or spa
Yes
No
Is the pool, Jacuzzi or spa fenced seperately from the rest of the yard
Yes
No
What is the lowest height of the fence around the pool/spa/jacuzzi in feet
Do you have a balcony?
Yes
No
Lowest height of balcony railing
Do you have a pool cleaner, gardener or housekeeper?
Yes
No
If yes, where will the cat/rabbit be kept while they are working
Is someone home during the day?
Yes
No
No. of hours cat/rabbit will be alone on weekdays
On weekends
Where will you keep the cat/rabbit when you are not home
Is anyone in your household allergic to cats/rabbits
Yes
No
Does anyone in your household smoke
Yes
No
Which of the following would you choose for flea control
Flea spray
Flea bath
Herbal flea control
Flea collar
Advantage/Frontline
Flea comb
Prescription program
Other
Identification methods you use on your pets
Collar with tag
Microchip
Other
What type of food will you feed your cat/rabbit
Wet
Dry
Raw
Describe your feeding schedule
What provisions/plans have you made for your pets in the event you become disabled or die
Where will your cat/rabbit spend the day
In the house
In the yard
In and out of house with dog door
Garage
Patio
Deck
Other
If other, please explain:
Where will your cat/rabbit spend the night
In the house
In the yard
In and out of the house with dog door
Garage
Patio
Deck
Other
If other, please explain:
Where will your cat/rabbit go when you are on vacation
With family
With pet sitter
At boarding kennel
At vet office
In the garage
With a friend
Neighbor will feed
Other
% of time your cat/rabbit will spend indoors
How will your cat/rabbit get exercise and activity?
What cat/rabbit behavior would not be acceptable to you
Explain behavioral concerns
Which of the following would force you to give up your cat/rabbit
Out-of-state move
Plans to have a baby
Longer work hours, schedule change
Divorce/separation
Return to school/college
Marrying/dating someone with cat/rabbit allergies
Cat/rabbit develops chronic illness
Large veterinary expenses
Loss of cat/rabbit bladder or bowel control
Cat howls a lot and neighbors complain
Cat/rabbit nips at strangers
Cat/rabbit is untrainable
Cat/rabbit exhibits separation anxiety
Cat/rabbit is destructive when not supervised
Cat/rabbit is not the kind I thought it would be
Cat/rabbit grew larger than anticipated
New cat/rabbit and current pets are not compatible
None of the above
Other
If other, please explain:
Veterinary
Vet's name
Vet's telephone number
Do we have your permission to call your veterinarian for records?
Yes
No
Are you prepared to cover any vet expenses your cat/rabbit may incur throughout its lifetime
Yes
No
What is a reasonable amount to spend if your cat/rabbit becomes very ill
How much is too much
What is your general veterinary ability
Within budget constraints
Will purchase pet insurance
Spare no expense
If a great expense, I would return the cat/rabbit
Would you consider euthanizing your pet because of any of the following (check all that apply)
Medical costs
Health suffering
Old age beyond life expectancy
Behavioral concerns
Current Pets
Do you have any current pets?
Yes
No
How do you feel your current pets will adjust to the new cat/rabbit
How do you plan to introduce the new cat/rabbit to your current pet(s)?
How many pets do you currently have?
0
1
2
3
4 or more
Name of current pet #1
Species (dog, cat, rabbit, etc)
Breed
Age
Weight
Sex
Male
Female
Is pet socialized with dogs and/or cats?
Cats
Dogs
Neither
Unknown
Name of current pet #2
Species (dog, cat, rabbit, etc)
Breed
Age
Weight
Sex
Male
Female
Is pet socialized with dogs and/or cats?
Cats
Dogs
Neither
Unknown
Name of current pet #3
Species (dog, cat, rabbit, etc)
Breed
Age
Weight
Sex
Male
Female
Is pet socialized with dogs and/or cats?
Cats
Dogs
Neither
Unknown
Name of current pet #4
Species (dog, cat, rabbit, etc)
Breed
Age
Weight
Sex
Male
Female
Is pet socialized with dogs and/or cats?
Cats
Dogs
Neither
Unknown
Past / Previous Pets
Have any of your pets died from parvovirus, distemper, feline leukemia or any other contagious disease
Yes
No
Have any of your cats been declawed
Yes
No
Vet who declawed cat
Age of declawing
Have you owned pets in the past who are no longer with you?
Yes
No
How many past pets have you had?
0
1
2
3
4 or more
Name of past pet #1
Species and breed
How obtained
Years you owned the pet?
Specifically, what happened to the pet?
Pet's vet
Vet's telephone number:
Name of past pet #2
Species and breed
How obtained
Years you owned the pet?
Specifically, what happened to the pet
Pet's vet
Vet's telephone number
Name of past pet #3
Species and breed
How obtained
Years you owned the pet?
Specifically, what happened to the pet
Pet's vet
Vet's telephone number
Is there anything else you'd like us to know when considering your application?
Please read the following statements and check all. By doing so you agree to each commitment.
I agree to a home visit prior to adoption. I understand that a member of the AALOC Kennel Committee will contact me within one week to set up a home visit if my application is approved, and neither the application nor home visit guarantees that the adoption will be approved.
I agree to a home visit prior to adoption. I understand that a member of the AALOC Kennel Committee will contact me within one week to set up a home visit if my application is approved, and neither the application nor home visit guarantees that the adoption will be approved.
I understand that a veterinary reference is required in order to adopt a pet from AALOC if you currently or previously owned a pet. If the veterinarian does not have records for my past/current pets, the application will be denied.
I understand that a veterinary reference is required in order to adopt a pet from AALOC if you currently or previously owned a pet. If the veterinarian does not have records for my past/current pets, the application will be denied.
Submitting this form constitutes your permission for us to check references. I am in full agreement with these terms of adoption. I agree that no member of my family/household has ever been charged with cruelty to animals or children, dog fighting or other crimes relating to animals.
Submitting this form constitutes your permission for us to check references. I am in full agreement with these terms of adoption. I agree that no member of my family/household has ever been charged with cruelty to animals or children, dog fighting or other crimes relating to animals.
I agree that I will provide the pet with adequate food, water, shelter, training, affection, and medical care.
I agree that I will provide the pet with adequate food, water, shelter, training, affection, and medical care.
I understand that Animal Assistance League of Orange County is not responsible for the accuracy of information received about the habits, temperament, or physical condition of pets available for adoption. I understand that it is my responsibility to evaluate the pet for myself before agreeing to adopt it.
I understand that Animal Assistance League of Orange County is not responsible for the accuracy of information received about the habits, temperament, or physical condition of pets available for adoption. I understand that it is my responsibility to evaluate the pet for myself before agreeing to adopt it.
I understand and agree that I must and will return the cat/rabbit to AALOC if I am no longer able to care for it. I understand that I may not take it to another animal shelter, humane society, other owner, research facility, or other organization.
I understand and agree that I must and will return the cat/rabbit to AALOC if I am no longer able to care for it. I understand that I may not take it to another animal shelter, humane society, other owner, research facility, or other organization.
I agree that all the information I have provided in the above application is true and honest. I understand and agree that if AALOC discovers an omission or information contained in this application to be false, AALOC reserves the right to annul the adoption and reclaim the animal from my premises without refund or money paid.
I agree that all the information I have provided in the above application is true and honest. I understand and agree that if AALOC discovers an omission or information contained in this application to be false, AALOC reserves the right to annul the adoption and reclaim the animal from my premises without refund or money paid.
I agree that AALOC shall not be liable for, and is hereby relieved from, all liability for any damage, expenses, cause of action, fines, suits, demands, judgments or claims of any nature whatsoever arising from or by reason of any damage to property or injury to any persons caused in whole or in part by the cat/rabbit placed in your home. I hereby accept and assume such liability and agree to protect, indemnify and hold AALOC harmless from and against all the aforesaid.
I agree that AALOC shall not be liable for, and is hereby relieved from, all liability for any damage, expenses, cause of action, fines, suits, demands, judgments or claims of any nature whatsoever arising from or by reason of any damage to property or injury to any persons caused in whole or in part by the cat/rabbit placed in your home. I hereby accept and assume such liability and agree to protect, indemnify and hold AALOC harmless from and against all the aforesaid.
I understand that an adoption donation is required. All dogs, cats and rabbits are spayed or neutered prior to adoption, vaccinated, dewormed, microchipped, and ID tagged. All cats are tested for Felv, FIV and ringworm.
I understand that an adoption donation is required. All dogs, cats and rabbits are spayed or neutered prior to adoption, vaccinated, dewormed, microchipped, and ID tagged. All cats are tested for Felv, FIV and ringworm.
Applicant signature
Date
Witness signature
Date
Submit