I would like to adopt: A ___________________ ______________________________
Animal ID Number Pet’s Name (if name is listed)
_______________________________________ _____________________________________
Your name Co-Adopter/Spouse Name (if applicable)
_____________________________________ ___________________________________________
Your Street Address/plus Apt or Unit # City, State, Zip Code, County
Home Phone: ____________________ Cell:___________________ Work:_______________________
E-Mail Address:________________________________________________________________________
Providing your e-mail address is volunteer. Broward County does not sell e-mail lists. However, the information contained
herein are public records that, absent an exemption, must be produced pursuant to a request under Chapter 119, Florida
Statutes.
___ Yes! I want to receive valuable pet-related information from Broward County and their partners.
___ No, I do not want to receive valuable pet-related information from Broward County and their partners.
Do You: ___ Own ___ Rent ___ Live with parents or another person
If you rent:
_______________________________________ _______________________________
Name of Owner/Property Manager Phone number of property owner or landlord
Do you know what your pet restrictions (if any) are where you live? ____ Yes ____ No
Who lives with you? _________ _________ __________ _________ __________
# of Adults # of Children # of Dogs # of Cats # of Other Pets
By signing below and submitting this Adoption Application, I agree that the information I’ve provided is true and correct.
I also verify that I am at least 18 years old and have never been convicted of animal cruelty or neglect. I understand
that by submitting this form, a representative from Animal Care will call me to discuss my application. I also understand
that the adoption of this pet is based on availability of the pet and that all Adoption Applications are processed on a
first-come, first-served basis. My adoption is not final until Animal Care has confirmed the adoption and I come to pick
up the pet at my assigned date and time.
______________________________ ____________________________ ______________
Signature (Application must be signed) Date (Application must be dated) Time
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