Adoption Form Owner Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Primary Phone*Secondary PhoneHow did you hear of us?* Website Sign Facebook Google Referral OtherPlease specify the animal(s) you are interested in adopting:Thank you for considering adopting a dog from our shelter. You will be making a 10-15 year commitment and our goal is to help make the best possible match for you and our shelter animals. The following questions will help us achieve that goal.Do you currently live in a: House Apartment Condo OtherDo you currently:RentOwnIf you rent, may we contact your landlord to verify their pet policy?YesNoLandlord’s NamePhoneHow many adults live in your home?How many children?If there are children in your home, what are their ages?Does anyone in your household have pet allergies?YesNoWho will be primarily responsible for the care of this pet?Is this pet a gift?YesNoIf yes, for whom?Where will the pet be kept at night?Pet InformationPet name*Species*DogCatBreed*Color markings*Date of birth or age*Sex*MaleFemaleSpay or neutered?*YesNoName of previous vet?*Would you like us to request medical records from previous caregiver?*YesNoIf yes please provide contact information for us:Add a second pet?*YesNoPet name*Species*DogCatBreed*Color markings*Date of birth or age*Sex*MaleFemaleSpay or neutered?*YesNoName of previous vet?*Would you like us to request medical records from previous caregiver?*YesNoIf yes please provide contact information for us:Add a third pet?*YesNoPet name*Species*DogCatBreed*Color markings*Date of birth or age*Sex*MaleFemaleSpay or neutered?*YesNoName of previous vet?*Would you like us to request medical records from previous caregiver?*YesNoIf yes please provide contact information for us:I grant Kittery Animal Hospital and Creature Comforts permission to post my pet’s picture and story on social media.*Yes!No, thank youWe will gladly prepare a written estimate if you desire (please ask your technician or doctor). This will be important to you since ALL SERVICES ARE DUE THE TIME SERVICES ARE RENDERED.We accept Cash, Check, Visa, MasterCard, Discover or Care Credit Card.Digital Signature*By signing this document you agree to accepting all financial responsibility for any and all treatments performed, and that you are at least 18 years of age or older.Date* Date Format: MM slash DD slash YYYY
