Provisional Pet Parent Application

Hi, nice to meet you

You have been listed as a provisional pet parent to someone who has recently submitted an adoption application to The Animal League. In accordance with our adoption policy, primary caregivers 75 years or older must provide a provisional pet parent who will be entrusted to care for the pet in the event of his/her passing.

Please complete the Provisional Pet Parent Application

Archie and Alvin rescued by The Animal League.

Provisional Pet Parent

Adopter’s Name

Who has listed you as their provisional pet parent?

Adopter’s First Name

Adopter’s Last Name

Do you agree to be a provisional pet parent for this person?

Yes

It depends

Please explain your previous answer.

Your First Name

Your Last Name

Have you ever adopted from us before?

Yes

If yes, who and when:

Please tell us the pet’s name, animal type, and date you adopted from us (e.g., “Butchie”, “dog”, “12/04”).

Your Phone Number

Your Email Address

! Email invalid. Please check for typos.

How many adults are there currently in your home?

Are you over the age of 75?

Yes

What is your date of birth?

Other

Will the dog be homed on a property with a fence?

Yes

Please tell us about all of the pets you currently have in your household.

Pets in the Household: Pet #1

Name (e.g., “Whiskers”)	Type (e.g., dog/cat)	Gender	Breed	Age	Spayed/Neutered?	Current on vaccinations/ heartworm prevention?

Pets in the Household: Pet #2

Name (e.g., “Whiskers”)	Type (e.g., dog/cat)	Gender	Breed	Age	Spayed/Neutered?	Current on vaccinations/ heartworm prevention?

Pets in the Household: Pet #3

Name (e.g., “Whiskers”)	Type (e.g., dog/cat)	Gender	Breed	Age	Spayed/Neutered?	Current on vaccinations/ heartworm prevention?

Pets in the Household: Pet #4

Name (e.g., “Whiskers”)	Type (e.g., dog/cat)	Gender	Breed	Age	Spayed/Neutered?	Current on vaccinations/ heartworm prevention?

Primary Veterinarian. Please list your primary veterinarian here. If you currently do not have pets, please list the last vet you visited.

Veterinarian’s Name	Veterinarian’s Telephone Number	Name of Veterinarian’s Practice (e.g., “Clermont Animal Hospital”)

What else would you like to share with us?

Please type your full name

This will serve as an electronic signature for this application.

Date

May we add you to our contact list for updates about our shelter and our pets? We only send out updates a few times per year and we never sell contact information. You may opt-out at any time.

Yes