In an effort to assure a more satisfactory guardianship we ask your cooperation in the completion of this application. Just as there are guidelines for the adoption of a child, so are there guidelines for the placement of animals.

Although Peaceable Kingdom eagerly seeks the prompt placement of its animal residents, experience has shown that some situations are not consistent with the welfare of the animal. An unsatisfactory placement can result in an unpleasant experience for your family and many times can traumatize the pet. We reserve the right to refuse any placement we consider unsatisfactory. This is not a reflection on you personally, but simply that a particular pet may not do well in your situation. We feel our experience in this area must be our guide to a successful placement.

Name:_________________________________ Driver's LicenseNumber:________________
Address:___________________________________________________________________
City, State and Zip:___________________________________________________________
Home Phone #: (____) __________________Work Phone #: (____)__________________
Reference: _____________________________ Contact Number: (____)_________________
My Veterinarian is:
____________________________________________________________
Do You?
____ Own your home?
____ Rent Landlords Name: _____________________________________
Contact Number: (____)_______________________
____ Other
My home is a(n): House _____; Apartment_____; Mobile Home_____; Townhouse_____
Household Size? _____ Number of Adults
_____ Number of Children; Ages? _____; _____; _____; _____
Why do you want this companion animal?___________________________________________________
Do you believe in spaying/neutering pets? Yes _____; No _____
Will your pet be kept indoors? ______________Outdoors? _____________________
Where will your pet be when you are not home?_______________________________________
Are you familiar with housebreaking/litter training procedures? Yes _____; No _____
Have you ever utilized any of the services of Peaceable Kingdom before? Yes _____; No _____
What services did you utilize?_____________________________________________________
What pets do you have now or have had in the past 5 years?
PET _________________ Age: _____ Sex: ____ Neutered? Yes___; No___ Status____________
PET _________________ Age: _____ Sex: ____ Neutered? Yes___; No___ Status____________
PET _________________ Age: _____ Sex: ____ Neutered? Yes___; No___ Status____________
PET _________________ Age: _____ Sex: ____ Neutered? Yes___; No___ Status____________
PET _________________ Age: _____ Sex: ____ Neutered? Yes___; No___ Status____________



Signature_________________________________________________ Date_____________

Witness__________________________________________________