Rescue the Animals, SPCA Adoption Application

Animal Name

Breed

Date

Email

First Name

Last Name

Home Phone

Work Phone

Home Address

City

State

Zip Code

Employer

Occupation

Employer Address

Number of Adults in the Household?

Number and Ages of Children

Type of Home

Apartment

House

Ownership of Home

Rent

Own

Answer these two questions only if you chose "Rent" under "Ownership of Home"

Are Pets Allowed?

Yes

No

Have you already paid your pet deposit?

Yes

No

Continue here if you did NOT answer "Rent" under "Ownership of Home"

Is there a yard?

Yes

No

Is there a fence? If so, please list the height and type of fencing. If NO fence, please explain how you will handle exercise and toilet duties.

How many hours a day will the animal be left alone?

How many days a week will the animal be left alone?

List all other animals you own. Please provide breeds, age, and sex of each.

List all cats and dogs you have owned in the past 5 years AND what happened to them.

Can we visit your home by appointment?

Yes

No

If No, Why not?

Is this animal going to be a gift?

Yes

No

If yes, please explain

Name, location, and phone number of your Veterinarian

Have you been convicted of a felony?

Yes

No

Are you a registered sex offender?

Yes

No

List 2 references

Reference 1

Name

Phone

Address

Years Known

Reference 2

Name

Phone

Address

Years Known

I understand that all medical costs and responsibility will be my own once the animal is adopted. I agree to keep the animal up-to-date on all vaccinations and also on heartworm preventative (dogs only). I also understand the the adoption fee is NON-REFUNDABLE. All animals may be returned, but we do not refund application fees. By checking , you certify that the above information is true and correct. Rescue the Animals, SPCA reserves the right to refuse an application at it's sole discretion.

Signature (Type or Sign)

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.