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 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!
