Response-O-Matic Form

Adoption Application

P.O. Box 1767, Chillicothe, OH 45601

All of our animals are in foster homes in Columbus and Chillicothe, Ohio.

Just complete this form. Click on Submit when ready to send.
Date:

Name:
Address:
City:
State:
Zip:
Email address:
Please re-enter your email address:
Home phone number:
Work phone number:
Cell phone number:

1. I am looking for a:
puppy
dog
kitten
cat
other
2. Breed
Age
Weight
3. Is there a specific pet that interests you?
yes
no
Name of pet:
4. Would you be interested in any other pet?
yes
no
5. Is this pet for a gift?
yes
no
6. Would you consider fostering a pet for a short period of time?
yes
no
7. Reason for wanting a pet
watchdog
companion
barn cat/mouser
breeding
hunting
family pet
guard dog for business
child's pet
companion for other pet
8. Would this be an:
inside animal
outside animal
9. Where will this animal sleep?

If outdoors, what type of shelter will you provide?

10. Ages of adults and children in the home:
11. Other pets (describe type, size, how many, ages, and where housed)

12. If you currently own cats, are they "real" cats (with claws) or are they de-clawed?
cats with claws
declawed cats
13. Have you had pets in the past?
yes
no

If yes, where are they now?

14. Name of veterinarian (current or past)

Vet's phone number:

15. Name of personal reference who you don't mind us calling:

Phone number of personal reference:

16. If your pet becomes sick or injured, are you financially willing and able to spend $500.00 or more for veterinary care?
yes
no

17. Do you or anyone in your household have allergies or asthma?
yes
no
18. Which of the following describes your home?
house
apartment
condonminium
farm
dormitory
mobile home
19. Do you rent?
yes
no
If so, does your landlord allow pets?
yes
no
20. If yes, name and phone number of your landlord:

21. Do you have a fenced yard?
yes
no

Describe the type of fence and the height:

22. Do you have scratching posts and/or cat furniture in your home?
yes
no
23. How do you plan to exercise the pet?

24. Who will be caring for the pet?
Name(s):

25. Have you or any members of your family ever been convicted of a crime related to animals?
yes
no

26. How many hours a day will your pet be home alone?
Where will you keep him while you are gone?

27. What arrangements will you be making when you take trips?

28. Who will be responsible for caring for the pet?
Name(s):
Address, City, State, Zip:
Phone:
Work phone:
E-mail Address:

29. Why did you decide to adopt a pet?

30. How did you hear about us?
Newspaper
Internet
Other:

Adoption fees - Dogs/Puppies $140.00; Cats/Kittens $75.00 - which includes health check, testing, vaccinations and spay/neuter. Adoption fees discounted for dogs over 5 and for two cats or kittens adopted together.
Please mail donations to: P.O. Box 1767, Chillicothe, OH 45601.
All of our animals are in foster homes in Columbus and Chillicothe, Ohio.