Metroport Humane Society Metroport Humane Society  
Placement Application

Please fill out this form as completely as possible.

Your name

Address: City, State Zip:

Phone:

E-Mail:

Type of animal? Cat Dog Other - Please specify:

Name of animal:

Breed (or assumed mix):

  

Cat or Dog's Age:

    

Spay/Neuter:

Male -Neutered

Male -Not Neutered

Female- Spayed

Female- Not Spayed

  

Vaccinations/Tests/Preventatives (Please select all that apply):

   

Rabies -Yes
Rabies- No

  

Flea prevention -Yes
Flea prevention - No

 

Feline Leukemia Test-Yes
Feline Leukemia Test -
No
   

Heartworm Test -Yes
Heartworm Test- No

  

Heartworm prevention -Yes
Heartworm prevention- No

   

Please Describe Any Medical Problems & Treatment Received (if any):

  

Do You Own This Pet?

Yes
No

 

If Yes, How Long Have You Had The Pet?

    

If You Found The Pet, Please Tell Us When & Where:

   

Reason For Listing Pet:

  

Behaviors (Cats), Select All That Apply:

 

Liter Box Trained
Inside Only

Outside Only

In & Outside

Good With Other Cats
Good With Dogs

Good With All Children

Good With Older Children Only

Good With All People

Wild

Afraid Of People

Shy/Timid
Friendly

Affectionate

Lap Cat

Aggressive

Scratches

 

Is this cat declawed?

  

Yes

No

 

Has this cat ever bitten a person or another animal?

  

Yes

No

  

If you answered yes above, please give details:

Behaviors (Dogs), Select All That Apply:

 

House Trained
Inside Only

Outside Only

In & Outside

Good With Cats
Good With Other Dogs

Good With All Children

Good With Older Children Only

Good With All People

 

  

Has this dog ever bitten a person or another animal?

  

Yes

No

  

If you answered yes above, please give details:

 

 

How Long You Will Keep Pet:

This Week
A Month
As Long As Needed

Until (Date):

 

Please Describe What You Feel Would Be The Most Suitable Home For This Pet:

  

 

Other Information About This Pet:

  

Please write a short paragraph to help advertise the pet. Stress the good points and most suitable home:

   

Donation Requested For The Pet:

  

How did you hear about us?

 

Please enter your Email Address Again:

 

If you have a picture, e-mail it to metroport9499@yahoo.com.

 

To submit your application, first click the continue button below. A confirmation page will appear. Please review your entries, then click "Continue" on the confirmation page to send your form.

  

 

    

 

Click the reset button clear your application and start over.

 

 

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