First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Cell Phone*
Drivers License #*
Do you have a Spouse
Please enter Name and Drivers License # of any adult in the household over 18
Number of children in the household? Choose one: 1 2 3 4 or more
Are you interested in adopting a specific species?* Choose one: Dog Cat Both
Gender preference?* Choose one: Male Female No Preference
Age preference
Good With
Activity Level
Sometimes AAT takes in pets that require a little bit more care. What conditions/special needs/medical needs are you NOT comfortable handling? Ex: Giving Medications, behavioral training, etc.*
Do you give permission for an AAT representative to visit your home to do a home check?* Choose one: Yes No
Do all adults in the household consent to a background check being performed? * Choose one: Yes No
Does anyone in the household have pet allergies?* Choose one: Yes No
Does anyone in the household have asthma?* Choose one: Yes No
Do all the adults in the household consent to fostering?* Choose one: Yes No
I Live in A Choose one: House Apartment/Condo Townhome/Duplex Manufactured/Mobile Home
My home is * Choose one: Rented Owned
Name of apartment complex or landlord *
Does your complex or landlord agree to you fostering?* Choose one: Yes No
Is there a size, weight, and/or breed restriction? *
Type of Fence?* Choose one: Wood Chain link Other N/A
Height of Fence*
How often does your family travel (3+ days away)? * Choose one: Weekly Monthly A few Times A Year Yearly Every Few years
Do you currently have any other pets? If so How many? Choose one: None 1 2 3 4 5 6+
What kind of pet?* * Choose one: Cat Dog
Are all the pets in your household current on their shots? Choose one: Yes No
Are all your dogs/cats spayed or neutered?* * Choose one: Yes No
Are all your dogs on monthly Heartworm preventive?* Choose one: Yes No
What brand and when was the last dose?*
Veterinarian's name
Veterinarian's phone
Where did you hear about AAT?*
Please enter Name and Date below*
