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Adoption Form

Downloadable forms

Adoption Form

Name of animal you are interested in adopting (required):

First Name (required)

Last Name (required)

Your Email (required)

Address City/State/Zip (required)

Phone Number: 1112223333 (required)

Birthdate: (required):

Are you employed? (required)

YesNoRetiredStudentOther (please specify)

Type of Residence: (required)

HouseCondoApartmentMobile HomeOther

(required) Do you: RentOwn

If you rent, does your landlord allow pets? 
YesNo

Landlord's name/Place where you rent 

Landlord's phone number

Do you plan to move in the near future? 
YesNo

Are other family members aware that you plan to adopt a pet?

YesNo

Reason for Adoption

CompanionshipWatchdogHunting4-HCompanion for another petGift (Write Name Below)

Name of Recipient of Gift

How many adults live in the household? (required)

How many children live in the household? (required) 

Ages of Children 

Do you have pets now? 
YesNo

What kind of pets? How many of each kind?

If you have pets, how many are spayed/neutered?

How many are current on vaccines

What kind of pets have you had in the past?

What happened to your last pet?

Have you ever lost a pet to:

PoisoningHit by a carDiseaseStrayedStolenOld AgeOtherNone

Have you ever had to give up a pet? (required)

YesNo

Why?

If you move in the future, will you be able to keep your pet?

YesNo

Are you aware of and prepared to meet the first year's cost of regular preventive veterinary care (approximately $100-$200), food, and supplies ($100-$150)?
YesNo

Is anyone in the house allergic to animals?

YesNo

Who is your current vet?

Vet phone number?

Will your pet live: (required)

InsideOutside

If inside, how do you plan to train?

If outside, how will it be confined?

Do you have a fenced yard?

YesNo

Do you feel willing an able to work with your pet to correct problem behavior if it should develop? (Barking, destructive clawing, jumping, or digging?)

YesNo

What are your ideas for dealing with such behavior? Please note that not all problem behavior can be corrected. Most behavior can be with patience, perseverance, and/or expert help.

Do you have and poisonous or toxic plants like ivy, philodendron, or poinsetta?

YesNo

If you have poisonous or toxic plants, would you be willing to place them out of reach or remove them from your home?

YesNo

Who will be responsible for your new pet's care? (required)

How many hours a day will your pet be alone?

How many days of the week will the pet be alone?

Where will your pet be kept when they are alone?

Your pet will be micro-chipped for permanent identification. Do you agree to register your pet with the manufacturer's database (this is free and will not cost you)? If you move, will you update this information with the manufacturer and A.P.E.?

YesNo

Note: Since your dog will be wearing a collar, please be sure to use a safe-dog type collar. These collars easily break off or expand to slip over the head if your dog is caught on something. Do not use a pinch or choke chain

(required) A.P.E., and Iowa Law require that adopted animals be altered (spayed/neutered). Do you agree with this policy?

YesNo

(required) Are you prepared to give your pet plenty of time to adjust to its new home? We encourage the 2-day, 2-week time-frame. It will take your pet approximately 2 days to become familiar with the new home and 2 weeks to become comfortable with the family and other pets. Will you give your new pet this time?

YesNo

(required) Would you consider adopting two pets for companionship, especially if there is often no one at home?

YesNo

(required) I certify that the information I have given is true. I authorize the investigation of all statements in this form. I understand that A.P.E. has the right to refuse any request for adoption. I agree to the outlined Adoption Policies

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