Animal Adoption Questionnaire

 

All animal adoptions by Black Pine Animal Park are carefully considered by the Board of Directors of the Professional Animal Retirement Center (PARC), our governing body.

 

The following questions are critical in determining if we can provide an appropriate, enriching, and healthy life for your animal in need.  Please provide honest, complete answers to each question.  In the event it is determined that Black Pine is not a good fit for your animal, our staff will make every effort to provide alternative, potential sources of help. 

 

Thank you for your cooperation.

 

Owner’s Name

 

Residing at Address   

 

Daytime Phone #    Evening Phone #

 

Email Address

 

License Plate Number of vehicle that will deliver animal 

(This information is required by the USDA if we adopt this animal.)

 

 

Animal needs new home because:

 

ANIMAL FACTS:                                               

Species of Animal (be specific please)    

 

Type of Animal (bear, cat, lizard, hoof stock, etc.)

 

Date of birth (estimate if necessary)    Age

 

Born in, check one:  Captivity   Wild     Unknown       

 

Sex of animal  Male  Female  Unknown 

 

Spayed or Neutered?  Yes    No

 

Approximate weight, in pounds, of animal 

 

Animal currently resides, check one:   Indoors   Outdoors   Both

 

Describe current accommodations, habitat, cage, etc.  

 

Will you provide us this animal's current habitat?  Yes  No

(For smaller animals, reptiles, etc., the chances of adoption are greatly increased if you will donate the habitat, toys, shelter, feed, or other existing items you have used to care for it.)

 

Are you be willing to make a monetary contribution to help the sanctuary fund the care of this animal?  Yes   How much can you give?    No

 

DIETARY INFORMATION:

 What type of eater is this animal, check one:

Carnivore, it eats only meat, chicken, rats, etc.

Herbivore, it eats only vegetables, fruits, grass, etc.

Omnivore, it eats both meats and plant life.

 

Describe current diet (list commercial feed brand names)  

 

 

Describe frequency of feedings 

(for example, eats twice a day, once a week, every 14 days, etc.)

 

BEHAVIORAL INFORMATION:

Is this animal handled by humans now?   Yes  No

If Yes, on a leash/harness?   Yes  No

Has animal traveled often?  Yes  No

 

Will animal load into taxi/carrier okay? Yes  No  Don't know

 

Is animal ever aggressive?  Yes  No       

 

Has animal seriously injured any human(s) before? Yes  No

 

Please share any other comments or experiences that may help us determine if we can properly keep this animal.  Be honest please.

 

Thank you for your responses.  We will review this information and be in touch with you within five days from date of receipt.  You may call 260-636-7383 with any additional questions, or email blackpine@blackpineanimalpark.com. 

 

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