| TWAIN (They Who Are In Need)
P.O. Box 1861 Media, PA 19063 610.566.2093 | |
| Please print this application and fill in all information thoroughly, it will help us to process your application more quickly. And mail to address above. | |
| Name:_________________________________________________ | Phone #
(Day):________________________________ no cell phones please |
| Address:_______________________________________________ | Phone #
(Eve):________________________________ no cell phones please |
| Address:_______________________________________________ | Best time to call _____ to ______p.m. |
| Email address:___________________________________________________ | |
| Would you like to adopt a dog? ___yes ___no (___small ___medium ___large dog) | |
| Would you like to adopt a cat? ___yes ___no (___ kitten ___young cat ___senior cat) | |
| Do you prefer a male or female?___male ___female ___doesn't matter | |
| If you are adopting a dog, where will it be kept? | |
| During the day?_______________________________________________ | |
| In the evening?_______________________________________________ | |
| When no one is home?_______________________________________________ | |
| Do you have a fenced in yard?___yes ___no | |
| If yes, what are the dimensions, including height of fence_______________________________________________ | |
| Do you have other pets?___yes ___no | |
| If yes, please specify type of pet(s) and number:________________________________________________________
__________________________________________________________________________________________________ | |
| List other pets you have owned in the past:________________________________________________________
__________________________________________________________________________________________________ | |
| Number of people in household ______adults ______children ____________________________Ages | |
| Veterinarian's Name:_________________________________________ | Phone:________________________________ |
| Address:_________________________________________________________________________________________ | |
| If you do not have a vet, would you accept our recommendation? ___yes ___no | |
| How did you hear about TWAIN?________________________________________________________________
__________________________________________________________________________________________________ | |
| Is there a particular animal you are interested in adopting?___yes ___no | |
| If yes, what is his/her name?________________________________________ | |
| Signature_________________________________________________ | Date____________________ |