Adoption Application:

The decision to adopt a pet is an important one. In order to insure that you and your pet will be happy for years to come, we need to find out about you and your family. This application will become part of your adoption contract with New Beginnings Animal Shelter, Inc. Each application is screened and references are checked. New Beginnings Animal Shelter reserves the right to refuse any adoption and has the right to repossess any animal if it is endangered, neglected, or if information on the application has been falsified. Thank you for your patience and cooperation Personal Data: Name: Spouse or Partner's Name: Address: City: State: Zip: Home phone: Email: Date of Birth: Drivers License #: Are you: Working Retired In School Homemaker Other: Employer: Work phone: Employer Address: Working hours:                                                               Household Information: Are there any other adults living in the household? Yes No If yes, list members below: Name: Employer's name: Work phone: Work hours: Maximum number of hours pet will be left alone daily? Who will be responsible for the pet? How many children are at home: Please list children ages: Do you? Own Rent Does your landlord/lease or co-op allow pets? Yes No Name of apartment complex, if applicable: Where will the pet be kept? Inside Outside Are you moving: Yes No If yes, when? Are any members of your household allergic to pets? Yes No                                                           Phone references (not living with you but can be reached by telephone): Name: Address: City, State, Zip: Phone:               Pet Information: List below any pets you have owned in the past 5 years: Type of pet: Age: Spayed/Neutered? How long did you have the pet? Do you still own? If not, why? YesNo YesNo YesNo YesNo YesNo YesNo If there are pets living with you now, have they been vaccinated?YesNo If yes, when? Veterinarian's Name: Address: Phone:                           You and New Beginnings Animal Shelter, Inc.: Have you applied to adopt from NBAS before? YesNo If yes, when? How did you hear about us? I would like to: Volunteer with NBAS Become a member           Adoption Information: Pet you are interested in: Cat Dog ID#: Age: Gender: MF MNFS Do you understand that: This pet will require time to adjust to your home? Yes No That it may not be housebroken and may have submissive wetting? Yes No That it may chew, eat plants, and/or scratch furniture? Yes No What steps will you take to correct this behavior? Would you object to a follow-up visit or phone call? Yes No What would be a good time to reach you at home?                                   I understand that New Beginnings Animal Shelter, Inc. reserves final judgment on every adoption application in order to match pets with suitable homes. I further understand that this application is subject to verification and may be turned down. I confirm that all of the information, which I have provided in this application, is true to the best of my knowledge. I understand that providing false information on this application will be grounds for denial of the application. If approved, I understand I will need to read and sign a legally-binding contract, promising to provide proper care and treatment of the animal as prescribed by NBAS, including continuing veterinary care.   Electronic signature: Date: