Dog Adoption Application :: Southside SPCA - Society for the Prevention of Cruelty to Animals

The information you provide in the following questions will help us ensure that you leave with a pet that will suit your lifestyle and experience as a pet owner which in turn will ensure the best possible circumstances for the pet.

PERSONAL & CONTACT INFORMATION
Name *
Phone (Home) *
Phone (Work)
Phone (Cell)
Email *
Age *
Occupation *
ABOUT YOUR RESIDENCE
Street Address *
City *
State *
Zip *
How long have you lived at this address? *
Residence Type *
Do you own or rent your home? *
If you rent, does your landlord allow pets?
Landlord's Name & Phone
Do you have a fenced yard? *
PET HISTORY
Have you had pets in the past? *
If so, what happened to them?
Do you have pets now? *
If so, please let us know the breed and age (of each pet)
Are your current pets spayed or neutered?
Have you ever adopted from us? *
If so, do you still have this pet?
If no, why?
Veterinarian Name & Phone
ADOPTION INFORMATION
Name of dog you are interested in *
Why? *
For whom are you adopting this pet? *
Does the person live in your home?
Pet will live with *

Adults
Children Under 7
Children Over 7
Senior(s)

(Check all that apply)
How many hours per day will the dog be left alone? *
Will the dog be kept indoors or outdoors when alone? *
Where will your pet spend most of its time? *
When outside, how will your pet(s) be housed or confined? *
Where will the dog sleep at night? *
Do you have a crate or safe isolation area for your pet(s) in your absence? *
Do you allow your pet(s) to sleep on furniture or beds? *
Would you adopt a dog that is not known to be housebroken? *
Do you plan on attending obedience classes with your new dog? *
Are you financially prepared to provide your pet with annual vet care? *
Are you aware of your community's animal ordinances, leash laws and number of animals you may own? *
Are you or anyone in your family allergic to dogs? *
How did you learn about us? *
Please verify the information you provided above. *

Yes, I certify that the above information is true and correct.
GENERAL INFORMATION
- Animals are accepted from all sources including previously owned, stray, abandoned or homeless.
- As we sometimes have no background information on the health or temperament of an animal or if the information provided to us is inaccurate, we do not guarantee the health or temperament of any animal.
- Although we screen both medically and behaviorally every animal that is placed out in the adoption area, certain types of problems will not demonstrate themselves until the animal is in a home situation or a specific period has lapsed (as in the incubation of certain viruses). There is always a some risk in adopting any animal form a shelter or humane organization.
- Some animals have lived in abusive or neglectful circumstances and will need both training and time to make them agreeable companions.
TO BE CONSIDERED AS AN ADOPTER, YOU MUST:
- Be 21 years of age or older.
- Not be a full-time student.
- Have photo identification showing your present address.
- Have the knowledge and consent of all adults living in your household. If you live with your parents, they must adopt the animal under their name.
- Have the knowledge and consent of your landlord or the person owning the premises where the animal will be residing.
- Understand that all fees are non-refundable.
- Understand that the adopter is responsible for all veterinary care and medical bills of the adopted pet.
- Understand that the Southside SPCA reserves the right to deny your adoption application for any reason.
- Understand that the Southside SPCA reserves the right to verify all information submitted on this application, including veterinary information.
Please verify that you understand the above information. *

Yes, I have read and understand the above.
Security Code: *

Dog Adoption Application

Before you adopt