I
Am Interested In:
Dog(s)
Cat(s)
Both
Number of pets I'm seeking to adopt at this time:
Name(s) of SPCA rescued pet(s) I'm considering:
(if submitting a general application for future selection of a pet,
please type "not decided" in this name field)
Personal
Information
Name:
Address:
City:
State:
Zip:
Home
Phone:
Work
Phone:
Spouse/Partner/Roommate
Name:
Email
Address:
Age:
ID/Driver's
License #
(optional for online application, but will be required before adoption
occurs)
Employment
Information
Are you currently (check all that apply):
Employed full time
Employed part time
Unemployed
Student
Retired
Other (Please explain)
If employed, name of employer:
Job title / line of work:
If student, where?
Family
Information
Please list the names and ages of all adults living
in the household:
Please list the names and ages of all children living
in the household:
Are ALL members of your household aware of and in
agreement with this adoption? If not, please list who is not in favor
of the adoption and the nature of their concern or objection:
Home
Information
Do you rent
or own
your home?
House
Condo
Mobile
Apartment
If you rent, please enter your landlord's name and
phone number (this is required information if you rent):
If you rent, are you familiar with your landlord's
pet policy?
Yes
No
If so, what is it?
DOGS - Do you have a fenced in yard?
Yes
No
If yes, what type and how high?
Adoption
Information
What is the reason you wish to adopt this animal? (Check all that
apply):
Love animals, want to help an animal in need
Companionship
My children will learn ow to be responsible/care for another creature
Want to breed
Looking for guard dog for property
Looking for mouse/rodent control for home, garage, barn, or another
building
Feel sorry for the animal
The animal is so cute, and I just can't leave it behind
Gift for someone (if so, who?)
Vet
Care
Are you willing to provide regular vet care for
your new pet?
Yes
No
What is your estimate of annual routine vet care costs for the animal
you plan to adopt?
Do you agree to have regular check up's for your animal, including
all vaccinations?
Yes
No
Can you afford regular vet care for your new pet?
Yes
No
Who is your current or past veterinarian?
Would you allow us to speak with your vet to obtain information on
the health care of your animals?
Yes
No
Current
and Past Pets
What animals do you currently own? List all excluding fish.
Please enter pet's name, type, age, where it was obtained, and whether
it is spayed/neutered.
Do your current pets wear identification tags?
Yes
No
If no, why not?
Are your current dogs licensed?
Yes
No
If not, why?
Are your pets' vaccinations current?
Yes
No
If not, why?
If dog(s), heartworm preventative?
Yes
No
If not, why?
If cat(s), have they been tested for feline leukemia?
Yes
No
Unsure
Please tell us about pets you've owned IN THE PAST who are no longer
with you:
Please include their name, type, age, and whether they are deceased.
If they are still alive, please explain why they are no longer with
you.
Please tell us about the animal's weekly schedule
as it relates to your schedule. Which hours during the day will your
pet routinely be home alone. For example, if everyone is at
work between 8 - 4 on Monday, you would write 8 - 4 in the Monday
box.
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Saturday:
Sunday:
When inside, how do you plan to keep your pet? Check all that apply:
Free inside house
Confined to crate
Inside a closed room
When/if outside, how do you plan to keep your pet? Check all that
apply:
N/A, indoors only
Tie-out chain
Garage
Patio area
Invisible fence
Fenced yard
Outside dog run
Leash and regular walks
Loose in yard unattended
Other, please explain:
Where will your pet be kept during the day?
At night?
Training
and Behavior
How will you introduce your new pet to any existing pets?
How do you plan to handle undesirable behavior such as chewing,
accidents in the house, spraying, scratching furniture, excessive
crying/barking, getting onto coutertops?
If adopting a dog, will you consider taking your dog to training
classes?
Yes
No
If adopting a dog, what type of exercise will it receive and how
often?
If adopting a cat, do you intend to declaw immediately, wait to
determine if declawing seems necessary, train to use a scratching
post, discourage scratching through behavior modification such as
a squirt bottle, other (please explain)?
Responsibilty
Who will be primarily responsible for the care of the pet?
How old is this person?
If your animal(s) were to survive you, who or what (such as a will)
would ensure that they would not be taken to the pound for disposal?
Have you ever taken one of your pets to the pound?
Yes
No
If yes, why?
How long will you keep the pet you are planning to adopt?
If you were to move in the future, what will you do with the animal
you plan to adopt?
If you are no longer able to keep the animal you adopt, do you agree
that you must either return the animal to the SPCA or find a suitable
new home for it and notify the SPCA of the change in ownership?
Yes
No
Furthermore, do you agree that if you cannot keep the animal you
adopt, you must house this animal until a suitable new home is available
or until foster home space opens up in the SPCA?
Yes
No
By submitting this form, I verify that the above statements
are true to the best of my knowledge.