Beaumont Animal Care – Adoption Application

Name

First

Last

Address

City

State/Province

Zip/Postal

Country

Phone Number

Email

Are you 18 years of age or older?

Yes

No

Do you or anyone in your household have pet allergies?

Yes

No

Do you currently have a veterinarian?

Yes

No

Is this your first time adopting from Beaumont Animal Care?

Yes

No

Do you have any children 10 or younger at home? (We use this information to help you find the perfect pet!)

Yes

No

ANIMAL TO BE ADOPTED (type)

Dog

Cat

ANIMAL TO BE ADOPTED (gender)

Male

Female

Spayed/Neutered?

Yes

No

Animal Name

System ID #

Animal Color

Animal Age:

ACKNOWLEDGEMENTS 1. I acknowledge receiving from Beaumont Animal Care custody of the above described animal. 2. I will comply with all City ordinances and state laws related to the proper and humane treatment of animals. 3. I understand that Beaumont Animal Care does not guarantee the age, health, training, or temperament of any animal. 4. Beaumont Animal Care reserves the right to decline any application.

I acknowledge all