Tender Mercies Pet Organization Adoption Application

Name of the cat/dog that you are interested in adopting:*

Contact Information:

Name or names (include any other person in your household who will be responsible for helping care for the cat/dog):*



Daytime phone and best time to call:

Cell phone and best time to call:

Place of employment. If you are unemployed, do you have an alternate source of income?

Are you financially prepared to provide regular flea control and veterinary care?

History of any current or past pets you have had:

Have you owned a pet before?

If you have owned a pet before, how many and for how long?

How many pets do you currently own and what type?

Have you ever taken an animal to a shelter?

Have you ever had to re-home an animal you owned? If yes, what was the reason?

Have you or anyone in your household ever been convicted of animal cruelty?

What vet do you currently use? Please provide vet’s name, address and phone number. If you do not currently have a vet, you must provide at least 2 non-family, personal references. Please include name, phone number.

Home Life:

Do you plan to keep the animal inside?

Do you plan to keep the animal outside? If so, what type of shelter will be available to him/her?

Do you have a fenced in backyard?

How many hours a day will your pet be alone?

Where will your animal spend its days?

Where will your animal sleep?

How many adults/children live in the house? (List children ages)

Does anyone in the home have any medical conditions or physical limitations that might cause difficulty in living with or caring for a pet? (If so, please explain)

Adoption Agreement:

If you adopt a kitten/puppy, do you agree to have them spayed/neutered at your own expense at 6 months?

Do you agree to no cosmetic surgery such as cropping ears, docking tails and declawing cats?

If I am approved for adoption, I agree that if for any reason in the future I decide I do not want the animal or cannot keep the animal for whatever reason, that I will notify Tender Mercies Pet Organization. I will not take the animal to a shelter or try to re-home the animal myself. I am also willing to pay a non-refundable $250.00 adoption fee.