Our application is easy. Questionnaire Name * First Name Last Name Phone (###) ### #### Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Date of Birth * MM/DD/YYYY Drivers License or ID Number Housing * I own my home. I rent my home. Pethealth * I give Pethealth Inc. consent to email me regarding my trial of pet health insurance. Yes No Animal Name * What is the name of the animal you are interested in? Veterinary Clinic * What is the name of your preferred veterinary clinic? My Animal Will Be Kept Primarily * Indoors Outdoors Cohabitants * What is your living situation? Alone With Spouse With Roomate(s) Children * Are there children in your household? No Yes Ages of Children Do you have any other animals? Yes No If you do have other animals, please list them. Does anyone in your household have animal allergies? * No Yes If yes, please describe allergies. What is your primary reason for wanting an animal? * Companion Mouser For Children For Gift 14. How did you hear about the pet you're applying for? (please select all that apply) * Visited the Shelter BMHS Website Newspaper Word of Mouth Facebook Instagram Twitter Digital Signature * 15. I confirm that I have completed this application truthfully and that I understand the adoption process. First Name Last Name Thank you!
