PET ADOPTION APPLICATION

Our goal is to find a loving, responsible and permanent home for the animals in our care. Please be thorough and complete with your answers. We look forward to assisting you in your choice of a pet companion.

Name___________________ Age_______ Today’s Date________

Address____________ City____________State______Zip_______

Home phone #____________Cell# __________Email___________

Employer______________________ Work Phone #_____________

What is your living situation?

_____own house _____rent apartment

_____rent house _____parent’s home

_____own trailer _____roommate’s home

_____rent trailer _____dorm room

If you rent, are pets allowed at your residence? ___Yes ___No ___Don’t know

Landlord’s name ___________________Phone # ______________

Please understand, we must verify with your landlord that he/she approves of a pet in your rental property before we can consider your application for this adoption.

How long have you been at current residence? _________________

Do you expect to move within the next year? ____________________

Age, gender and relation of others living in your home?_______________ ________________________________________________________________________________________

Are any of the above mentioned people allergic to this type of pet?__Yes __No

If yes, whom?___________________________________________

Specific Pet Desired: DOG CAT

Animal # _________ Breed_______________ Age____________ Sex__________

1. Is this pet specifically for your household? _____________________________________________
2. Do you have pets now? ____Yes ____No How many? _____

Pet type Name Sex Age Altered Current vac's

1. ____________________________________________________

2. ___________________________________________________

3._______________________________________________________________________

4._______________________________________________________________________

Vet’s name _____________________ Phone # _____________

3. Please list any other pets you have owned in the last 5 years, what became of that pet.

1.__________________________________________________________________________

2.__________________________________________________________________________

3.__________________________________________________________________________

4.__________________________________________________________________________

4. Where will the pet spend the day? (be specific, please) __________________________________________________

Where will the pet spend the night? (be specific, please) __________________________________________________

5. How many hours per day will the pet be alone?______________

6. If adopting a dog, do you have a fenced yard? __Yes __No
Describe fence ______________________________________

If there is no fence, how will you keep the dog at home? __________________________________________________

Are you familiar with crate training? ___Yes ____No House training? ____ Yes ____No

7. Are you aware that the average dog/cat costs in excess of $500 per year in just food and vaccinations and that the average lifespan can be 15 years? ____________

8. Have you ever had a pet that you gave away or returned to an adoption agency? ____ Yes ____No

9. Since most shelter animals have unknown medical backgrounds, are you willing to take your new pet to the vet for a complete checkup within 7 days of adopting him/her? ______ Yes ________ No

10. Are you willing to provide and pay for any necessary medical treatment and/or yearly vaccinations that your new pet may need? _____ Yes ______ No

11. Do you agree that if, for any reason, you must give up this pet, it will be returned to this Shelter unless otherwise agreed upon by this Shelter? _____Yes _______ No

12. Would you allow a home visit by a representative of the Scott County Animal Shelter? ____Yes ____No

The answers given on this application are true to the best of my knowledge.
Please Initial ____

~Please read carefully ~

Disclaimer:

Our animals are not for sale, they are for adoption. Therefore, each home must be approved. The approval process includes, but is not limited to, completing this form, interviewing the prospective adopter and signing the contract. The Scott County Animal Shelter reserves the right to turn down a prospective adopter at anytime for any reason during this process.

I have read and understand the above disclaimer:

Signature_______________________________________________

Map to our shelter

[Home] [Information] [Shelters] [Search]