Do you

By signing below, I certify that the information I have given is true, and I realize that any misrepresentation of facts may result in my losing the privilege of adopting a pet.  I understand that the BVAS has the right to deny my request to adopt an animal for any situation that would be contrary to the shelter’s adoption policies, in violation of any state or local ordinances, or not in the best interest of the animal.  I authorize investigation of all statements in this application.  I also authorize my veterinarian to release any information requested by the BVAS.

Signature_______________________________________________    Date__________________________________________

Name

Address

City

State

Zip

Home Phone

Work phone

Cell phone

Do you live in a

Landlord

Landlord's phone

Do you have a fenced yard

Fence type and height in feet

How many adults in your household?

How many children and their ages

I am looking for a

Did you use PetFinder

PetFinder ID by name

Where will the dog/cat be kept during the day?

At night?

Spayed or neutered?

Textarea

Please list all animals that currently live in your home or have lived with you over the past 5 years.

   Are all the animals you have now up to date on their rabies and distemper? vacinations?  Y  N

What veterinarian have you used for your animals?

Vet Name:

Clinic Name:

Clinic Phone Number:

Agreement

Initial

Your Email

       Species                                      Breed                                        Pet’s Name                              Age                                 Sex