Metroport Humane Society - Roanoke, Texas

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

Has this cat ever bitten a person or another animal?

Yes

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

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.

Click the submit button once to send your application.

Click the reset button clear your application and start over.

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