Nantucket Safe Harbor for Animals · NiSHA Pet Adoption Questionnaire

Dear Prospective Adopter,

Thank you for choosing adoption! Please answer the following questions and we will talk about any questions you have.

Contact Information

Name

*

First Name

Last Name

Age

*

Your Age

Email

*

Verify Email

*

Email Newsletter Opt In

*

I would like to receive your monthly e-newsletter.

Yes

No

Phone

*

Permanent Mailing Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Military Personnel

Are you a current or former military member?

Yes

No

Please list names and ages of others in household, including children.

*

Home/Living Situation

*

Do you own your home, rent, or live with someone else? We welcome adopters who rent, or live in an apartment or condo. We want to alert you that some landlords and management companies have size and breed restrictions, limits on number of pets, and/or require pet deposits or additional fees, and therefore we do call landlords.

Own

Rent or Live with someone else

Please provide the name of your landlord/homeowner.

*

Landlord/Homeowner Contact

*

If you rent or live with someone else who owns the house, please provide their name and phone number.

Please provide the names and phone numbers of two references who are not family members.

*

Please provide the name and phone number of your veterinarian if you have had a pet in the last 7 years.

*

Interested in Animal

*

What kind of pet are you considering adopting?

Cat

Dog

Rabbit

Bird

Reptile

Other small and furry

Are you interested in a specific pet we currently have for adoption? If so, who?

*

Have you had pets before? If so, what kind and how many?

*

Please tell us about your current pets, including type, age, sex, and whether they are spayed or neutered.

*