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2. Applicant Information
4. Name
5. Email Address
7. Address
9. City
10. State
11. Zip Code
13. Cell Number
14. Work Number
16. Spouse or Roommate
17. Phone Number
19. Emergency Contact
20. Phone Number
24. Family/Household Information
26. Number of Adults in Household
28. Number of Children in Household
30. Have all the adults in the household agreed to this adoption?

    1. Yes
    2. No
32. Is anyone in the household allergic to pets?

    1. Yes
    2. No
34. Do you have an adequately fenced yard?

    1. Yes
    2. No
36. Why would you like to adopt an animal from us? (Check all that apply)

    1. Campanion for self
    2. Campanion for child
    3. Campanion for another pet
    4. Campanion for other household member
    5. Gift
    6. Watch Dog
    7. Hunting Dog
    8. Other
38. If Other...
40. Do you:

    1. Rent your home
    2. Own your home
41. Do you live in:

    1. House
    2. Apartment/Condo
    3. Other
42. Complex Name or Explain Other
44. **Renters:
46. Landlord/Property Management Name:
47. Phone Number:
49. Have you paid a pet deposit?

    1. Yes
    2. No
53. Pet Information
55. Pet Name:
57. Breed
58. Sex
59. Sterilized
60. Age
62. Pet Name:
64. Breed
65. Sex
66. Sterilized
67. Age
69. Pet Name:
71. Breed
72. Sex
73. Sterilized
74. Age
78. Veterinarian Information
80. Veterinarian's Name
81. Veterinary Hospital
85. New Pet Information
87. Are you committed to providing a responsible home for your pet's entire life (15+ years)?
89. How long have you been looking for a pet?
91. Who will care for your pet when you go on vacation or have an emergency?
93. Where will your pet be kept during the day?
95. Where will your pet be kept at night?
97. Are you planning to train your pet yourself or go to a trainer?
99. How much time are you prepared to allow for your new pet to adjust to your home?
101. Are you prepared to handle behavior issues such as chewing, digging, barking, begging, marking, aggression and separation anxiety should they arise?

     1. Yes
     2. No
103. May we contact you in a few months to see how things are going with your new pet(s) and get feedback on your adoption?

     1. Yes
     2. No
107. By signing below, I hereby submit that the information provided by me is true. Any false information may result in my losing the privilege to adopt a pet. I understand that Catoosa Animal Control has the right to deny my request to adopt an animal and that this application must be completed and approved by Catoosa Animal Control, before an animal adoption may be considered.
109. Date:
     Date:
111. Electronic Signature Agreement

     By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

     1. I agree.
113. Electronic Signature
Leave This Blank:


117. 1. Receive an email copy of this form.
118. Email address

     This field is not part of the form submission.

119. Submit Submit and Print

* indicates a required field