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Dog Adoption Application

* = required field

Date *

Dog’s Name *

For *

Foster

Adoption

Store Location

PetSmart – Bloomingdale

PetSmart – Golf Road

Petco – Bloomingdale

Adoption requirements:

(1) Be at least 21 years of age, (2) Have the consent of all adults living in the household, (3) Have approval from the residence owner, (4) Have valid ID with current address, (5) Be a resident of Illinois, (6) Be approved by Almost Home Foundation as a suitable adoptive home, and (7) Have a one-week trial to ensure the fit is satisfactory, (8) Pass a veterinarian reference check for current and past pets.

Name *

Age(s) *

Driver’s License Number

Address *

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City

StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces (AA)Armed Forces (AE)Armed Forces (AP)American SamoaGuamNorthern Mariana IslandsPuerto RicoUS Minor Outlying IslandsUS Virgin Islands

Zip code

Home Phone *

Work Phone

Cell Phone

Email *

Do you work full or part time?

Full-time

Part-time

Unemployed

Retired

How long have you been employed at your present job?

Employer Name

City

Do they match donations made to 501c3 not-for-profit organzations *

Yes

Residence information (residency requirements will be verified) *

Do you Own?

Do you Rent?

Type of Home *

Apartment

Condo

Townhouse

Single Family

How long have you lived at your present address?

Any plans to move in the near future? *

Yes

Do you have a fenced yard? *

Yes

Fence Height

If renting,

Does your lease allow dogs? *

Yes

Is a deposit required? *

Yes

Is there a weight limit *

Yes

Is your landlord aware you intend to adopt an animal and have they given permission?

Yes

Landlord’s name

Landlord’s phone number

Name and Address of Housing Complex

Did you bring a copy of your lease?

Yes

Number of adults

Their relationship to you

Number of children

Children’s ages (in years)

Is this dog intended for your immediate family?

Yes

Person primarily responsible for your new dog?

Any history of allergies in your family?

Yes

If so, what?

What is your family’s current lifestyle:

Very Active

Active

Moderate

Often Home

Number of hours you work per day

Number of hours your dog will be left alone per day

Pet History (for pets your currently own, or have owned in the past five years)

Enter Name

Type/Breed

Sex

Male

Female

Age

Spayed/
Neutered

Yes

Still Own?

Yes

If no, what happened to the pet?

Enter Name

Type/Breed

Sex

Male

Female

Age

Spayed/
Neutered

Yes

Still Own?

Yes

If no, what happened to the pet?

Enter Name

Type/Breed

Sex

Male

Female

Age

Spayed/
Neutered

Yes

Still Own?

Yes

If no, what happened to the pet?

Enter Name

Type/Breed

Sex

Male

Female

Age

Spayed/
Neutered

Yes

Still Own?

Yes

If no, what happened to the pet?

What inoculations has your current pet had in the last year?

Have you ever given a pet away or relinquished a pet to a shelter?

Yes

If yes, what were the circumstances?

Have any of your pets ever been (check all that apply)?

Lost

Hit by a Car

Put to Sleep

Given Away

If yes, what were the circumstances?

New Pet Information

Why do you want to adopt a pet? (please check all that apply)

Companion

Companion for another animal

Gift

To breed

For a child

To teach responsibility

Protections

Watch Dog

How many times a day will you take your pet outdoors?

Will you take your pet to obedience class?

Yes

Where will the pet be kept when you are at home?

Inside

Outside

Garage

Where will the pet be kept when you are not at home?

Do you plan on crating your pet?

Yes

If so, when, why, and for how long

Are you aware of the general pet care costs (food, inoculations, medical care, boarding, incidentals)?

Yes

Do you travel often with work or for vacation?

Yes

How often?

Weekly

Monthly

Yearly

Who will care for your pet in your absence?

What kind of ID will be kept on the pet?

How much time are you prepared to allow the pet to adjust to your home?

What will you do in the event of: (required)

Barking problems

Aggressive behavior

Chewing/Digging

Housebreaking problems

In case of emergency, who will care for the pet? *

What veterinarian (or hospital) have you used or are going to use?

Name:

City:

Phone:

Name:

City:

Phone:

Are you aware of the licensing regulations and fees in your village?

Yes

Do you know the leash laws of your area?

Yes

Are YOU aware of the grooming costs for the breed that you are considering for adoption?

Yes

Please list 3 personal references along with phone numbers (neighbor, friend, relative – at least one required):

Phone:

Relationship:

Phone:

Relationship:

Phone:

Relationship:

Almost Home

How did you hear about Almost Home Foundation?

If it was a newspaper, which one?

Would you like information on becoming an Almost Home member?

Yes

Do you have any questions or concerns?

l, the undersigned certify that the information provided in this application is complete and accurate to the best of my knowledge. I understand that any misrepresentation of facts will result in my losing the privilege of adopting an animal from Almost Home Foundation. I realize that Almost Home Foundation has the right to deny my request to adopt an animal either because the individual animal is not suitable to my circumstances or on a more general basis. I understand that this application becomes the property of Almost Home Foundation, and all information given herein is for Almost Home Foundation’s use alone. I along with those persons accompanying me, assume risk of injury which may be incurred as a result of my viewing any animal under the care of Almost Home Foundation.

Signature *

Date *

If you are human, leave this field blank.

Cat Adoption Application

* = required field

Date *

Cat’s Name *

Adoption requirements:

(1) Be at least 21 years of age, (2) Have the knowledge and consent of all adults living in the household, (3) Have approval from the residence owner, (4) Have valid ID with current address, (5) Be approved as a suitable adoptive home by Almost Home Foundation, and (6) Live in the Greater Chicagoland area, (7) Pass a veterinarian reference check for current and past pets.

Name *

Age *

Driver’s License Number or State ID *

Address *

City

Zip code

Home Phone *

Work Phone

Cell Phone

Email *

Do you work full or part time *

Full-time

Part-time

Retired

Not employed

How long have you been employed at your present job?

Residence information (residency requirements will be verified) *

Do you Own?

Do you Rent?

Type of Home *

Apartment

Condo

Townhouse

Single Family

How long have you lived at your present address?

Any plans to move in the near future? *

Yes

If renting,

Does your lease allow cats? *

Yes

Is a deposit required? *

Yes

Is there a weight limit *

Yes

Is your landlord aware you intend to adopt an animal and have they given permission?

Yes

Landlord’s name

Landlord’s phone number

Name and Address of Housing Complex

Did you bring a copy of your lease?

Yes

List All Household Members

Full Name *

Relationship to You *

Age *

Full Name

Relationship to You

Age

Full Name

Relationship to You

Age

Full Name

Relationship to You

Age

Full Name

Relationship to You

Age

Full Name

Relationship to You

Age

Full Name

Relationship to You

Age

Is this cat intended for your immediate family?

Yes

Person primarily responsible for your new cat?

Any history of allergies in your family?

Yes

If so, what?

What is your family’s current lifestyle:

Very Active

Active

Moderate

Often Home

Number of hours you work per day

Number of hours your cat will be left alone per day

Pet History (for pets your currently own, or have owned in the past five years)

Pet Name

Type/Breed

Sex

Male

Female

Age

Kept where?

Indoor

Outdoor

Spayed/
Neutered

Yes

Declawed

Yes

Still Own?

Yes

If no, what happened to the pet?

Pet Name

Type/Breed

Sex

Male

Female

Age

Kept where?

Indoor

Outdoor

Spayed/
Neutered

Yes

Declawed

Yes

Still Own?

Yes

If no, what happened to the pet?

Pet Name

Type/Breed

Sex

Male

Female

Still Own?

Yes

Age

Kept where?

Indoor

Outdoor

Spayed/
Neutered

Yes

Declawed

Yes

If no, what happened to the pet?

Pet Name

Type/Breed

Sex

Male

Female

Age

Kept where?

Indoor

Outdoor

Spayed/
Neutered

Yes

Declawed

Yes

Still Own?

Yes

If no, what happened to the pet?

What vaccines has your current pet had in the last year?

Have you ever given a pet away or relinquished a pet to a shelter?

Yes

If yes, what were the circumstances?

Have any of your pets ever been (check all that apply)?

Lost

Hit by a Car

Put to Sleep

Given Away

If yes, what were the circumstances?

New Pet Information

Why do you want to adopt a cat/kitten? (please check all that apply)

Companion

Companion for another animal

Gift

To breed

For a child

To teach responsibility

Where will the cat/kitten be kept when you are at home?

Inside

Outside

Garage

Where will the cat/kitten be kept when you are not at home?

Do you plan on using a cage?

Yes

If so, when, why, and for how long

Are you aware of the general pet care costs (food, vaccines, medical care, boarding, incidentals)?

Yes

Do you travel often with work or for vacation?

Yes

How often?

Weekly

Monthly

Yearly

Who will care for your pet in your absence?

What kind of ID will be kept on the pet?

How much time are you prepared to allow the cat/kitten to adjust to your home? *

What will you do in the event of: (required)

Litter Box Accidents *

Spraying *

Scratching People *

Scratching other Pet *

Climbing Curtains *

Hiding *

How would you introduce your cat/kitten to animals in your home *

What will you do if introduction does not go well *

What mood is a cat in when its tail is swishing back and forth and its ears are laying back *

Under what circumstances would you give up your cat *

In case of emergency, who will care for the pet? *

What veterinarian (or hospital) have you used or are going to use?

Name: *

City: *

Phone: *

Name:

City:

Phone:

Are you aware of the licensing regulations and fees in your village?

Are YOU aware of the grooming costs for the breed that you are considering for adoption?

Please list 3 personal references along with phone numbers (neighbor, friend, relative):

1. – Full Name *

Phone: *

Relationship: *

2. – Full Name *

Phone: *

Relationship: *

3. – Full Name *

Phone: *

Relationship: *

Almost Home

How did you hear about Almost Home Foundation?

Would you like information on becoming an Almost Home member?

Yes

Do you have any questions or concerns?

Signature *

Date *