Dog & Cat Adoption Application
Beaumont Animal Care
1884 Pine St
Beaumont, Texas 77703
409-838-3304
Name (First, Middle, Last) _______________________________________________________________
Address: ______________________ City: ___________________ State: _________ Zip Code: _________
Date: ____________________ Phone Number: ___________________________________
Are you 18 years of age or older:
□Yes □No
Email Address (if applicable):_____________________________________________________________
Do you or anyone in your household have pet allergies? □Yes □No
Do you currently have a veterinarian? □Yes □No
Is this your first time adopting from Beaumont Animal Care? □Yes □No
Do you have any children 10 or younger at home (we use this information to help you find the
perfect pet)?
□Yes □No
ANIMAL TO BE ADOPTED – TO BE COMPLETED BY BEAUMONT ANIMAL CARE STAFF
Type: □Dog □Cat | Gender: □Male □Female | Spayed / Neutered: □Yes □No
Name: _______________________ System ID #: ______________________________
Color: ___________________________ Weight: _____________________________________
Age: ____________________________ Rabies Tag Number
: _________________________
1. I acknowledge receiving from the Beaumont Animal Care Division custody of the above
described animal.
2. I will comply with all City ordinances related to the proper and humane treatment of animals.
3. I understand that Beaumont Animal Care does not guarantee the health, training, or
temperament of any animal.
4. The City reserves the right to decline any application.
Applicant Signature: ____________________________ Date: ________________
