COMMUNITY SERVICES | Irvine Animal Care Center

SMALL ANIMAL ADOPTER SURVEY

Thank you for your interest in adopting a new family member from our center. In an effort to help you find your match please provide the following information.

First Name

Last Name

Age

Drivers License Number

Preferred Phone

Alternate Phone

Street Address

City

State

Zip

How many adults live in your household?

How many children live in your household?

Do you own or rent your residence?

Own

Rent

If you rent, please provide landlord contact information:

ANIMAL INTERESTED IN:

Which animal are you interested in adopting?

Other:

I want this animal for (check all that apply)

Myself

My Children

Family Pet

Companion/Other Pet

Gift

Please list other pets in the home:

What is your experience with the animal that you are interested in?

First time owner

Had one or two

Experienced

Who will be primarily responsible for this animal?

What type of housing will this animal be kept in?

Where will this animal be kept?

Garage

Inside

Outside

Mostly inside

Mostly outside

Both inside and outside

What questions do you have about the care and husbandry of this animal?

The adoption of an animal is a commitment for the life of an animal and should be a carefully thought out decision. Since this a lifelong companion, are you willing to make the investment in both time and finances to care for and properly manage your new pet?

Yes

Thank you for your honest answers. The information you provide will help us find a pet that is suitable for you.

The City of Irvine takes your privacy seriously. This form asks you to provide the City with certain personal information. Such information is being requested and will be utilized by the City for the specific and limited purpose of future City correspondence regarding the subject-matter of this form. Pursuant to Measure S, an initiative ordinance passed by City voters in 2008, all information provided on this form will be kept confidential. Unless you expressly indicate to us otherwise or unless compelled by a court order, it will not be shared with other agencies, businesses or individuals.