Office Use Only:
Cat ____
Dog ____
Name: ______________
Shelter ID #: _________
Date:
_________
Dog and Cat Adoption Application
Thank you for filling out this profile. The questions that we ask and the information that you
provide helps us make the best match for you and your family.
Adoption Requirements:
 Complete the adoption application. This form along with an interview process ensures that
each animal adopted is matched into a compatible new home.
 Verification that you are 21 years or older
 Proof of home ownership or lease indicating that your landlord will permit a pet in your
home.
 Be willing to spend the time and money necessary to provide training, care, and medical
treatment for your pet
Applicant Information:
First and Last Name: ____________________________________________________
Physical Address: ______________________________________________________
City: ________________________ State: ____ Zip: _____________
Mailing Address (if different from above): ___________________________________
City: ________________________ State: ____ Zip: _____________
Home Phone: ______________________ Cell Phone: ________________________
Email: ____________________________ Your Age: _____
References:
We require several references before completing an adoption. This is to ensure that your new pet
will be provided with a stable home environment and Veterinary care. Until references have been
contacted the adoption is not complete.
 If you have had a pet in the past 3 years please list your Veterinarian’s name and phone
number:
_______________________________________________________________________
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Please list two personal references:
1. Name: ______________________________
Phone Number: _______________
Relationship: _________________________
2. Name: ______________________________
Phone Number: _______________
Relationship: _________________________
If you own your home please provide proof of home ownership such as a property tax bill or
mortgage statement. If you are renting please provide your landlord’s name and phone
number.
Landlord Name: _____________________________ Phone Number: _________________
Housing Information:
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Type of housing (please check one)
___ Apartment ___House ___Condo/Townhome ___Mobile Home
Do you: ___Own or ____Rent your residence?
Are you willing to allow TVCAS staff to visit your home by appointment? ___Yes ___No
If you move, will your pet go with you? ___ Yes ___ No
How many adults live in your household? _____
How many children under the age of 18 live in your household?____
Do all members of your household want this pet? ___Yes ___No
Environment Questions
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Are you able to provide a permanent home for this pet for 10-15 years? ___Yes __No
Your dog or cat ownership experience:
___First time owner ___Have had one or two ___Knowledgeable and Experienced
How long are you away from home?
____ Home all day ___ Out for less than 4 hours at a time ___ Away for 7-10 hours daily.
Your dog or cat will live?
___Indoors only ___Indoors/Outdoors ___Outdoors only
Please check the one that most describes your home atmosphere
___Bustling with people ___Some activity ____Calm and Quiet
Current/Past Pets
How many pets do you currently have? _____
Dogs: ______
Cats: _______
Type: __________________________
Age: ___
Gender:_____
How long have you owned this pet? __ yrs.
Up to date on their vaccinations? ___Yes ___No Spayed or Neutered? ___Yes ___No
Where does the pet stay? ___Indoor ___ Indoor/Outdoor ___ Outdoor
How many pets have you owned in the past? _______________________________
Name of Veterinarian: _____________________________________
TVCAS Dog and Cat Adoption Form (Feb 2014)
Page 2
Ownership Questions
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Are you willing to keep a collar and tags on your new dog or cat? ___Yes ___No
When you are not home where will your dog or cat stay?
____loose in house ___kenneled in house ___tied outside ___loose outside ___fenced yard
outside
Are you able to provide adequate exercise for your new dog or cat? ___Yes ___No
How will you prevent your new dog or cat from running loose?
_____________________________________________________________________________
How much can you afford to spend to care for this animal each year? (food and veterinary
costs)
____less than $100 ___ $100-$500 ____$500-$1000 ___$1000 +
Are you willing to pay for veterinary care for your new pet? Annual visits cost approximately
$100 and emergency visits can cost upwards of $200.
____Yes ___No
Do you understand that a rescued animal will take some time to adjust to its new home
environment? ___Yes __No
How will you train your new pet to correct inappropriate behavior?
______________________________________________________________________________
______________________________________________________________________________
What kind of behavior(s) would cause you to possibly return him/her to us?
______________________________________________________________________________
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Do you agree not to give the animal to anyone else without notifying TVCAS?
TVCAS Dog and Cat Adoption Form (Feb 2014)
__Yes __No
Page 3
Terms and Condition for Adoption
By signing this application I have read and agree to abide by the following terms and conditions:
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I will not allow my pet to become a public nuisance because of loud or frequent barking, biting or
intimidating passers by, running loose or other behavior that may infringe upon the rights of others.
I will provide proper and sufficient food and fresh water on a daily basis to my new pet.
I will have adequate facilities at my residence that will protect my new pet from the elements and
provide a space that will allow him/her to freely move about.
I will provide any and all veterinary treatment that my new pet may require throughout his/her
lifetime.
I will return him/her to TVCAS if I am unable to properly care for my new pet.
I will not sell, give away, or abandon my new pet without first contacting TVCAS.
I will not mistreat, abuse, engage in fights, or use my pet for experimental or medical research
purposes OR allow anyone else to do so.
I will allow TVCAS to review my home at any reasonable time and remove my pet if the home is
unsuitable or if its officers determine my pet is being neglected or mistreated in any way.
I will abide by any Local, State and Federal laws that pertain to my new pet.
I will pay all reasonable costs, including court costs and attorney fees incurred by TVCAS in enforcing
this contract if I fail to comply with its terms.
I understand TVCAS makes no representations or guarantees about any animal’s temperament or
health and that a pet’s behavior may change after it leaves the shelter and acclimates itself to a new
home.
It is the recommendation of the Association of Shelter Veterinarians that upon adoption all cats
leaving the shelter should be retested by the new owner’s veterinarian no sooner than 60 days from
the last negative test. One negative test is not a guarantee of disease free status. I assume any risks
or costs associated with this testing.
Any comment that an animal may be good with children or other animals or is housebroken is based
upon information provided by the previous owner or staff evaluation.
I accept ___________________________________________________ as is and assume all risks
(Name of Animal)
of its ownership, including the risk of injury or damage caused by the animal (such as animal bites). On
behalf of myself, my heirs, personal representatives and assigns, I hereby release, discharge, indemnify and
hold harmless the TVCAS and its directors, officers, employees, and agents from any and all claims, causes of
action and demands of any nature, whether known or unknown, arising out of or in connection with my
adoption of said animal.
By signing below, I am attesting to the truthfulness of my answers. Falsification of any of the above
information will be grounds for disallowing the adoption of a TVCAS dog or cat and possible removal of an
adopted dog or cat from my home and fines up to $150.00 dollars.
TVCAS reserves the right to refuse any applicant.
__________________________________________
(Signature)
TVCAS Dog and Cat Adoption Form (Feb 2014)
__________________
(Date)
Page 4
OFFICE USE ONLY
HOLD
FOSTER
ADOPTED
Has adoption form been completed fully and signed? Yes No
Please include the following in adoption (please check all that apply)
Food Toy Medical paperwork Adoption packet Spay/Neuter Certificate
License (if from Teton County, ID) Collar& Leash Tag #_________Rabies Tag #_______
Borrowed item _________________________________________________________
Cash
Check _________
Visa
Master Card
Amex
Discover
Money Order
_____________________________________
(Employee Signature)
Hold
Adoption
Food
Toys
Deposit
Total
$_________
$_________
$_________
$_________
$_________
$_________
_________________________________
(Date)
Notes:
TVCAS Dog and Cat Adoption Form (Feb 2014)
Page 5