Ayres Adoption Application
Application for (Animal Name)
Alice (Dog - 2020-47)
April (Dog - 2014-20d)
Barn Kitten - 3 (Cat - 2020-67c)
Barn Kitten - 4 (Cat - 2020-68c)
Bella (Cat - 2016-144c)
Bobby (Dog - 2016-15d)
Camper (Dog - 2016-58d)
Captain (Dog - 2019-26d)
Clark (Cat - 2020-72c)
Creamsicle (Cat - 2019-12c)
Dillon (Dog - 2020-7)
Dixie (Cat - 2019-34c)
Eden (Cat - 2020-76c)
Frisco (Cat - 2020-18c)
Gia (Cat - 2020-20c)
Graham (Dog - 2019-40)
Higgins (Cat - 2020-21c)
Huck (Dog - 2018-73)
Ike (Cat - 2020-85c)
Kitty (Cat - 2018-32c)
Molly (Dog - 2019-73d)
Nikki (Dog - 2019-36d)
Obi (Cat - 2020-35c)
Penny (Cat - 2020-25c)
Preston (Dog - 2020-26d)
Sam (Cat - 2020-41c)
Sara's Kits (Cat - 2020-69c)
Sara's Kits (Cat - 2020-70c)
Sassy (Cat - 2017-133c)
Tino (Dog - 2019-50)
Tuck (Dog - 2013-50)
Wren (Cat - 2020-55c)
Xyla (Cat - 2020-56c)
Yager (Dog - 2019-13)
Yoyo (Cat - 2020-57c)
Ziggy (Dog - 2020-27d)
Please Specify if this app isn't for a specific pet, but to keep on file:
Applicant's First Name
Applicant's Last Name
Drivers License Number / State
Drivers License Number / State
Primary Phone Number
Employer Address/Phone Number
Length of Employment
Length of Employment
If Self employed, do you operate your business out of your home? Will Clients interact with the new pet?
If unemployed or self employed, are you able to provide a verifiable source of income to support pet care expenses?
How long have you lived at your current address?
If less than one year, please provide previous address
Do you currently live in a:
If you answered "other" above, please explain here:
If mobile home, is it in a trailer park?
Live with a Relative(Your relative owns the home that you live in.)
Rent to Own
If you rent or live with a relative, please provide us with Name and Phone Number
If you live in a trailer park, please provide park name and a contact number.
Does your lease allow pets?
Are there breed restrictions?
Please describe any restrictions on breed, weight, behavior or number of pets
Is their a pet deposit? How much is required? Has it been paid?
Do you intend to move over the next year?
Does your insurance cover the breed of dog that you are interested in adopting?
Describe your household
How many people live in the household total?
List all adults who live in the home aside from the applicant's listed above. (Name/Relationship/Age)
Are all adults in the home on board with bringing a new pet into the home?
Are there children in the household?
Will children be involved in daily pet care?
Do relatives or friends bring children to visit?
Ages? How frequently do they visit?
Is anyone in the home allergic to pets? Explain
Is someone home during the day?
Post Covid - will someone continue to be home during the day?
On average, how long will the pet be left alone?
Where will this pet be kept when home alone?
Free roam in house
Garage Doggy Day Care Neighbors Home Other
If other, please explain
When outside, will the dog be in a:
Partially Fenced Yard
Electric Fence Free Roam Leash Walked
If you have a fenced yard, how tall is it? Made from what Material? Is it in good condition?
Do you own any pets currently?
Please list dogs: Name, Age, Breed, Spayed/Neutered, Up to Date on Shots & How long you have had this pet:
Please list cats: Name, Age, Spayed/Neutered, Up to Date on Shots, FeLv/FIV tested,& How long have you had this pet?
Do friends or relatives bring pets to visit? If yes, how frequently and what kind of pets?
A pet needs to be seen by a veterinary AT LEAST ONCE A YEAR for annual vaccinations and examinations. Average routine vet care costs between $400 and $600 per year. Are you willing and able to provide regular vet care for your new pet?
If getting a pet under 4 months old, do you plan on spaying or neutering?
After one litter
Who is your current veterinarian? Please list Clinic Name, Phone Number and whose name the animal is under. (If you do not have any pets presently - please list a vet that you have used in the past 10 years with pet name(s))
In order for us to do a vet reference, you will need to call to give your vet permission to speak to us. Please do that if you have not already. If you are unwilling to do that, please explain.
Have you owned pets personally in the past?
Please list previous pets you/the co-applicant have owned personally. Please include: Name, Species, How long you had the pet and where the pet is now.
Do you understand that a new animals takes times to acclimate to a new home?
How long do you consider a reasonable adjustment period for a new pet?
How long have you been searching for a new pet?
Have you adopted a pet from Ayres before? If yes, when? What pet?
Have you ever adopted a pet from a rescue/shelter before? If yes, what rescue/shelter?
Have you have been denied adoption at any organization? Explain.
Have you ever given up an animal? If yes, when? What were the circumstances? To whom?
Have you ever had a pet go missing? What did you do to find that pet? Were you successful? What steps did you take to help keep your pet safer at home?
What kind of pet are you looking to adopt?
Reason for adopting a new pet? Check all that apply.
Companion for other pet
Emotional Support Dog
What ideally are you looking for in a new pet?
What size/breed are you looking to adopt?
What Gender and Age Range are you looking to adopt?
Is there a specific color and hair length/type that you are looking for in a new pet?
What activity level would you like your new pet to ideally have? Please note that adopted pets can go home and be more rambunctious or more mellow when they settle into a new home.
What reasons would you give up a pet? Explain.
What traits are undesirable to you in a new pet?
Have you ever owned the breed of dog that you are applying for before?
I understand that at least one reference must be a non relative/spouse, and the references must not include vet reference or landlord.
Please list reference one: Name, Relationship, Phone Number and/or email
Please List Reference 2. Name, Relationship, Phone Number and/or email address
Additional Information you may want us to know about you:
To help us better know where to showcase our animals, please tell us where you heard about our shelter/this animal?
If other above or if a friend recommended us, please let us know who:
I certify that the above information is true and correct. I understand that falsification or omission of any information will result in denial of adoption. Ayres Memorial Animal Shelter, Inc reserves the right to approve or deny adoption to anyone for any reason. Our main interested is in the well being and the proper placement of each animal as an individual. Please initial.
I understand that if I am unable to keep this pet, that I am legally bound to return it to the Ayres Memorial Animal Shelter, Inc. Please Initial
In order to be considered for adoption, you must: (Please select all that apply)
-Be 21 years of age or older and have verifiable photo identification.
-Have the knowledge and consent of your landlord/relative to own a pet.
-Be willing and able to spend time and money necessary to provide training, medical treatment and proper care for a pet.
-Understand that the submission of this application is not a guarantee of being approved to adopt any animal.
-It is shelter policy to make follow up calls or emails after the pet has been adopted.
-It is part of our adoption process to reserve the right to do a home visit for dog adoptions.
-Understand that the adoption fee is non refundable.
-Understand that some animals will not be adopted to homes with kids or other pets based on staff temperament assessment.
Applicant Signature (if on mobile device)
Type Signature for Co-applicant