DeWitt Animal Hospital, P.C.

5620 Thompson Road
DeWitt , NY 13214

(315)446-1200

dewittanimalhospital.org

Adoption Application Form

Date (required) :
Applicant Information:
Applicant Name: (required)
First Name (required)
Last Name (required)
Applicant Phone: (required)
Phone TypePhone Number (required)
Co-Applicant Name:
First Name
Last Name
Co-Applicant Phone:
Phone TypePhone Number
Current Address: (required)
Street Address (required)
City (required)
,
State / Province (required)
Zip / Postal Code (required)
Ownership: (required) :
Landlord/Parents Name:
First Name
Last Name
Landlord/Parents Phone:
Phone TypePhone Number
Length of time at current address? (required)

Who will be the primary caretaker for the new pet? (required)
First Name (required)
Last Name (required)
Who is your current or previous veterinarian? (required)

How would you describe your experience with pets? (required) :
How long are you away from home on the average day? (required) :
Our pet will live: (required) :
Who shares your household? (required) :
Our home atmosphere is: (required) :
How did you hear about us? (required)

Please tell us about your current companion animals:
Pet One:

Pet Two:

Pet Three:

Please tell us about the companion animals you have had in the past 5 years:
Past Pet One:

Past Pet Two:

Past Pet Three:

References:
Vet Reference:

Personal Reference: (required)

About the cat you wish to adopt:
Age (Check all that apply):
Kitten (less than 6 months)
Young adult (1-3 years)
Adult (3-6 years)
Senior (6+)
Coat (Check all that apply):
Short
Medium
Long
No preference
Gender: :
About the dog you wish to adopt:
What breed of dog would be ideal for you?

Size as an adult (Check all that apply):
Small (0-20 lbs)
Medium (20-50 lbs)
Large (50-100 lbs)
Giant (>100 lbs)
Coat (Check all that apply):
Short
Medium
Long
Non-Allergenic
No preference
Age (Check all that apply):
Baby(6-12 weeks)
Puppy (less than 1 year)
Young adult (1-3 years)
Adult (3-6 years)
Senior (6+)
Activity Level (Check all that apply):
Very active/athletic
Some long walks/runs
Couch potato
Gender :
Spay/Neuter
Do you want to have this animal spayed/neutered? If no, why? (required)

Agreement
By signing this application you authorize Dewitt Animal Hospital?s employees to contact your landlord, reference and Veterinarian and to obtain any vet records that you may have. Any adoption is subject to the approval of this application. We reserve the right to refuse any applicant. Once this application is completed and signed, it becomes the property of Dewitt Animal Hospital and will not be returned to the applicant. We do not use the information provided for any reason other than considering you for adoption of an animal.
Step 1. By checking this box and typing my name below, I am electronically signing my application.
Step 2. Electronic Signature (Type your name) (required)
First Name (required)
Last Name (required)

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