515.460.7729

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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)

 Yes No Retired Student Other (please specify)

Type of Residence: (required)

 House Condo Apartment Mobile Home Other

(required) Do you:  Rent Own

If you rent, does your landlord allow pets? 
 Yes No

Landlord's name/Place where you rent 

Landlord's phone number

Do you plan to move in the near future? 
 Yes No

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

 Yes No

Reason for Adoption

 Companionship Watchdog Hunting 4-H Companion for another pet Gift (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? 
 Yes No

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:

 Poisoning Hit by a car Disease Strayed Stolen Old Age Other None

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

 Yes No

Why?

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

 Yes No

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)?
 Yes No

Is anyone in the house allergic to animals?

 Yes No

Who is your current vet?

Vet phone number?

Will your pet live: (required)

 Inside Outside

If inside, how do you plan to train?

If outside, how will it be confined?

Do you have a fenced yard?

 Yes No

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?)

 Yes No

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?

 Yes No

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

 Yes No

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.?

 Yes No

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?

 Yes No

(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?

 Yes No

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

 Yes No

(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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