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Captures eligibility and safety factors such as age, license details, household allergies or asthma, prior legal or ordinance violations, and knowledge of local pet ownership requirements. Includes questions on home and yard setup, pet care plans, exercise and potty training, pet restrictions, prior surrendered pets, and experience with dogs. Provides tables for current cats and dogs plus personal and vet references.","| Payment type |  |  |  | Is it entered into Square ( for checks enter pet ID number, name and check number, for cash pet ID number and name of person) |\n| --- | --- | --- | --- | --- |\n| Amount | Cash | Check | Credit |  |\n|  |  |  |  | For staff only |\n\n\n| Adoption Date | Pet ID \\# |\n| --- | --- |\n|  |  |\n| Pet Name | Pet Description |\n|  |  |\n\n\n| Adopter’s First and Last name | Resident Address (not P.O. BOX) |  |\n| --- | --- | --- |\n|  |  |  |\n| City | State | Zip |\n|  |  |  |\n| Cell Phone | Home Phone | Email Address |\n|  |  |  |\n\n\n| Driver’s License \\# | State Licensed | Are you 21 years or older? | Obtain a copy of the Driver’s License or State IDfor the records |\n| --- | --- | --- | --- |\n|  |  | Yes No |  |\n\n\n| How would you describe your age? |  |  |\n| --- | --- | --- |\n| Young\u003Cbr>Adult\u003Cbr>21-35 | Adult\u003Cbr>36-65 | Mature\u003Cbr>adult\u003Cbr>65+ |\n|  |  |  |\n\n\n| I Live In a |  |  |  |  |\n| --- | --- | --- | --- | --- |\n| Single\u003Cbr>Family\u003Cbr>Dwelling | Condo | Apartment | Mobile home | Other (describe) |\n|  |  |  |  |  |\n\n\n| I would describe my home as |  |  |  |\n| --- | --- | --- | --- |\n| Quiet/calm | Moderately\u003Cbr>Active | Grand Central\u003Cbr>Station | Other (describe) |\n|  |  |  |  |\n\n\n| Do you |  | If renting, name and number of Landlord |\n| --- | --- | --- |\n| Own | Rent |  |\n|  |  |  |\n| Name and ages of the adults in the home? |  | What are the ages of kids in the home? |\n|  |  |  |\n\n\n| Is anyone in the household allergic to pets or has asthma? |\n| --- |\n| Allergies Asthma No I don’t know |\n| If you answered yes to any, what would you do to deal with a pet allergy if adopting a pet? |\n|  |\n\n\n| Have you ever been in violation of the law/ordinances pertaining to pets? |  | Yes No | Date of violation |  |  |  | City, State |  |  |  |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n| Details of violation |  |  |  |  |  |  |  |  |  |  |\n| \u003Cbr>Do you know the government pet ownership requirements for the city or county you live in?\u003Cbr>YES NO |  |  |  |  |  | Do you have breed restriction?\u003Cbr>YES NO |  |  |  | \\# of pets allowed |\n|  |  |  |  |  |  |  |  |  |  |  |\n| Describe any pet restrictions (if you have any) by your landlord, homeowner’s/renter’s insurance, subdivision or city? |  |  |  |  |  |  |  |  |  |  |\n| Have you ever surrendered a past pet to a shelter, rescue group or gave away? |  |  |  |  |  |  |  |  | YES NO |  |\n| If yes please explain the circumstances |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |\n| Do you have a fenced in yard? | What type of fence do you have? |  |  |  |  | Height of fence? |  | Do you have a doggy door? |  |  |\n| Yes NO |  |  |  |  |  |  |  | YES NO |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |\n| What would you do if the new pet would chew on things? |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |\n| If you were to lose the house, apartment you live in, what would your plan be for the pets in your home? |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |\n| How would you provide exercise? |  |  |  |  | What would you do about potty training if needed? |  |  |  |  |  |\n|  |  |  |  |  |  |  |  |  |  |  |\n\n| What is the purpose of this adoption? |  |  |  |\n| --- | --- | --- | --- |\n| For self | Gift | Companion for\u003Cbr>another pet | Guard dog |\n|  |  |  |  |\n\n\n| Will your new pet have |  | Describe level of experience with dogs |  |  |  |\n| --- | --- | --- | --- | --- | --- |\n| Limited\u003Cbr>use of\u003Cbr>house | Full use of\u003Cbr>house | Novice | Somewhat | Seasoned | Expert |\n|  |  |  |  |  |  |\n\n\n| Where are you going to keep the dog |  |  |\n| --- | --- | --- |\n| Inside only | Inside / outside | Outside only |\n|  |  |  |\n\n\n| Some of our dogs may have special needs. If you adopt one with any of the following needs, we expect that you will follow treatment recommendations. |  |\n| --- | --- |\n| Special medication\u003Cbr>Special food\u003Cbr","cbCaidlIscFo3bsS","https://ap.wps.com/l/cbCaidlIscFo3bsS","pdf",570701,1,3,"English","en",105,"# Adoption and Payment\n## Payment type and amount\n## Adoption date and pet ID\n# Adopter Information\n## Name, address, and contact\n## Driver’s license and eligibility\n## Age and living situation\n# Home and Household Conditions\n## Home description and housing type\n## Household allergies or asthma\n## Yard, fence, and doggy door\n## Pet restrictions and local requirements\n# Past Pet History and Care Planning\n## Past violations and surrendered pets\n## Plan if housing changes\n## Chewing, exercise, and potty training\n## Adoption purpose and pet experience\n# Current Pets and References\n## Current cats table (FELV/FIV, shots, vet care)\n## Current dogs table (heartworms, preventatives)\n## Personal and vet references","[{\"question\":\"What information does the adoption application collect for the adopter and payment?\",\"answer\":\"It collects the adopter’s full name, resident address, city/state/zip, phone numbers, email, driver’s license/state ID details, and whether the adopter is 21 or older. 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