ADOPTION APPLICATION

Administrative only

Adoption Form

Date
Case#
Adoption Rep

First Name

Last Name

Date of Birth

Address

Address Line 1

Address Line 2

City

Country

Select

State/Province

Select

Zip Code

Phone Number

Please note all fields are required. If the question does not apply to you type in N/A ( OR ) choose N/A in the drop down box.

Name of the pet you are interested in

Did you ever adopt from us or any other organization?

Employer

Do you have any children living with you?

Yes, I do
No, I don't

What are their ages?

Have the children been around animals?

Does anybody in the family have allergies to animals?

Do you currently have any animals? How many?

Name of animal(s)

Dog/Cat/Other

Age(s)

Breed

Are all of your animals up to date on vaccinations? List animal names.

Any kind of health issues?

What kind of health issues?

Are your animals current on their medications?

Are your current pets spayed or neutered?

YES
NO
Both yes and no
N/A

Which pets are NOT spayed or neutered?

If not spayed or neutered, why?

Which pets are spayed or neutered?

Who is your current Veterinarian?

Current Vet Phone Number

The SPCA reserves the right to contact your veterinarian for a reference and follow-up questions

Where do your current animals live primarily?

Indoors
Outdoors
Indoors and outdoors

Do you own or rent your home?

Rent
Own

Landlord's Name

Landlord's Phone Number

Where is the animal going to live?

Indoor only
Outdoor only
Indoors & outdoors

Will the animal have access to a dog house, home, outdoor shelter, other

If other, please explain

Is the yard fenced?

Did any of your previous pets die?

Cause of death?

What type of animal are you looking for?

Puppy
Dog
Kitten
Cat

If you are interested in a puppy, what size do you want the dog to be when it is an adult?

Check all that apply

Small (less than 25lbs)
Medium (26-50lbs)
Large (over 50lbs)

Are you looking for a specific breed, color, or sex?

What are you looking for?

If adopting a cat or kitten are you considering getting the animal declawed?

Why do you want a new pet?

Where will the animal be kept during the day?

Is anybody home during the day?

Their name:

Can they handle the animal?

Where will the animal be kept during the night?

Will you be crating your animal when you are away for a while?

Where will you keep your animal when you are away for a while?

Who will take care of the animal during vacations?

Do you understand it can take a while for an animal to be housebroken?

Are you willing to take the time to work with the animal to become housebroken?

Do you understand it can take a while (weeks to possible months) for the animal to become adjusted and integrated into your family?

Do you understand animals are needing regular veterinary care?

How much are you willing to spend on veterinary care?

What do you feel as a valid reason to give a pet away? (please list all that apply) Fleas / too expensive / shedding / scratches or chews furniture / new place that does not allow pets / moving to another state / getting married or divorced / having a baby / unwilling to take care of animal anymore

If you are unable to take care of the animal, what do you plan to do with it?

If you had or have an animal, what type of problems did you encounter with them?

What did you do about these problems?

What happened to any previous pets that you have owned but are no longer with you?

Did any animal ever get stolen, lost, disappear or die at an early age, please describe the circumstances.

Have you ever given away or surrendered an animal?

Because the SPCA of the Triad is trying to find the best match for our animals we reserve the right to turn down any potential applicant.

There is a processing time to allow us to check with your landlord and veterinary to make sure a pet is permissible. We appreciate your patients.

I certify that I have answered all questions honestly and to the best of my ability. I understand that any misrepresentations of fact may result in removal of the adopted pet from my home

Electronic signature or type your name in. This will be your electronic signature you understand all questions and comments and have answered all questions honestly.

Thank you for submitting!

Thank you for submitting!