Adoption ApplicationPaul Klein2019-05-28T20:01:00-07:00Adoption ApplicationStep 1 of 9 - Application Information0%EntryIDApplicant InformationName* First Last Phone*Email* Enter Email Confirm Email Marital Status*SingleMarriedSeparatedDivorcedAge*ReferencesPlease provide two referencesName* First Last Phone*RelationshipParentSiblingAunt/UncleCousinFriendOtherName* First Last Phone*RelationshipParentSiblingAunt/UncleCousinFriendOtherAddressCurrent Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Have you been at this address for more than two years?YesNoPrevious Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code EmploymentOccupation*Employer*Have you been with this employer for more than one year?*NoYesPrevious Occupation*Previous Employer*Are you a US Citizen?*NoYes Co-Applicant InformationIs there a co-applicant for this adoption?*YesNoName* First Last Age*Marital Status*SingleMarriedSeparatedDivorcedPhone*Email* Enter Email Confirm Email Co-Applicant EmploymentOccupation*Employer*Have you been with this employer for more than one year?*NoYesPrevious Occupation*Previous Employer* Have you or any member of your household have a history of allergies to animals or asthma?*YesNo Please Note: We do not have pure-bred kitties that are hypoallergenic.Are there other people living in the house with you?*YesNoPlease indicate each member of your household in the appropriate tables below.Adult Members of Your Household (Age 18 and Over)AdultsNameAgeRelationship Minor Members of Your Household (Under Age of 18)MinorsNameAgeRelationship Related to Family MembersIs everyone in the household in agreement about this potential adoption?*YesNoOther (gift/surprise)What will you do if you have a roommate / family member who may be allergic?*Have you or any member of your family been accused of and/or found guilty for animal neglect, cruelty or similar offense?*YesNo Household InformationHome Type*HouseCondo / TownhomeMobile HomeApartmentOtherIf Other, please explain*Home Status*OtherOwnLease PurchaseRentLive with FamilyPet Deposit*Additional Pet Rent*Rental Restrictions for Pets (i.e. max 2 pets)Landlord*Landlord Phone*If Other, please explain*Please select all that apply to your current home Doggie Door Pool Fenced Yard Acreage Livestock / Farm AnimalsDo You Plan to Move in the Future?*NoYesWhat Will You Do if Your Future Residence Does Not Permit Pets?*Under what conditions would this animal be outside?*Do you have animals visit your home regularly?*NoYesIf Yes, what type and how often?*Do you have children visit your home regularly?*NoYesIf Yes, what age and how often?*What will you do with the animal if you have to move?* List All Past and Present Pets for at least the past 10 years.Current PetsDo you currently have any pets?*NoYesCurrent Pets*NameSpecies / BreedSpayed / NeuteredAge / Years OwnedYear Last Vaccinated YesNo Previous PetsHave you previously had any pets?*NoYesPrevious Pets*NameSpecies / BreedStatusAgeYears Owned DeceasedRehomed Additional Explanation for Previous Pet(s)General Pet History InformationHave you ever had a cat declawed?*NoYesNever had a catIf Yes, please explain*Have you ever had a cat with Feline Leukemia or AIDS?*NoYesNever had a catHave you ever rehomed an animal or surrendered an animal to a shelter or rescue group?*NoYesIf Yes, please explain*VeterinarianCurrent Veterinarian*Emergency Veterinarian* Animal of InterestName of animal you are interested in*Have you met this animal in person?*YesNoWhat is the reason for adopting this animal?*Personal CompanionFor my KidsGiftProtectionMouserOtherIf Other, please explain*What do you like about this animal?*Do you have experience with the breed?*What personality traits do you like in a animal?*What personality traits do you dislike in a animal?*Describe any personal situations that might cause you to have to return this animal?*How many hours per day will this animal be alone?*Under what circumstances would you consider declawing (Cat) or tail docking / ear cropping (Dog)?* Behavior ChallengesIn each of the fields below, please explain how you would handle each of the behaviors listed.Scratching*House Soiling*Fearful / Shy*Clashes with Current Pets*Financial ConcernsProperly cared for animals can cost between $500-$1,000 per year. This includes yearly vaccinations, vet checkups, supplies, food, water and litter. Are you financially able and willing to spend at least this amount each year?*YesNoAre you aware that adopting an animal is a lifetime commitment that may span 20 years or more?*YesNoIn an emergency, what amount are you willing to pay for veterinary costs?*What would you do with a bill greater than that amount?*If for any reason you are unable to care for this animal (e.g. injury, illness, finances, death, etc), what would happen to him/her?* DiscoveryHow did you hear about us?* In Store Pet Search Site Friend / Family Social MediaIf In Store, please specify store Location*PetSmart Chandler, AZ (Gilbert and Germann)PetSmart Tempe, AZ (Guadalupe and McClintock)PetSmart Ocotillo (Chandler, AZ) (Ocotillo and Arizona)PetSmart Mesa, AZ (McKellips and Power)PetSmart Phoenix, AZ (Camelback and N 20th St)PetSmart Phoenix, AZ (Ahwatukee) (Ray and S 46th Pl)Other StoreIf Other Store Location, please specify store*If Pet Search site, please specify which site*If Social Media site, please specify which site* DisclaimerBy submitting this application, I/We attest that the information provided herein is accurate to the best of my/our knowledge. I/We understand that the following information is requested so that Saving One Life can assist me / us in the selection of a lifetime companion. The animal's welfare is Saving One Life's foremost concern. Saving One Life reserves the right to deny adoption to anyone. I have read, reviewed and agree to all stipulations described above*YesNoSubmit Application This iframe contains the logic required to handle Ajax powered Gravity Forms.