DCSPCA Adoption Application

WELCOME TO THE DUTCHESS COUNTY SPCA SHELTER AND ADOPTION CENTER
We are glad you have come to adopt a new pet from our shelter

FOR OFFICE USE ONLY

Name/Animal #

__________________

In order to be considered as an adopter today, you must:

Be 18 years of age or older
Have identification showing you present address
Have the knowledge and consent of your landlord
Be able and willing to spend the time and money necessary to provide training, medical treatment and proper care for a pet

THE DCSPCA RESERVES THE RIGHT TO REFUSE ADOPTION TO ANYONE

The following information is requested so that your adoption counselor can assist you in the selection of a new pet. The animal's welfare is our foremost consideration. The consultation process is designed to help us determine if the adoption is in the animal's best interest, and to assist you in finding an animal most compatible with your lifestyle.

The animals available for adoption came here from a variety of sources. All animals are examined upon entry and their health is routinely monitored while at the shelter, but there is always a chance that an animal is incubating a disease without showing any clinical signs. After the seven day health guarantee, any adopted animal is the sole responsibility of the adopter.

Our adoption fee includes: the first series of vaccinations, leukemia testing or heartworm testing (as applicable), fecal exam for parasites and any medication and a seven day health guarantee. All adopters will also be given a complimentary one year membership and be placed on our mailing list.

PLEASE FILL OUT THE FOLLOWING QUESTIONNAIRE. UPON COMPLETION IT WILL BE REVIEWED BY ONE OF OUR ADOPTION COUNSELORS. (Please answer all of the questions)

NAME_________________________________ DATE____________________

ADDRESS _______________________________________________________

CITY____________________________ STATE_________ ZIP_____________

HOME PHONE___________ WORK PHONE_____________ E-MAIL__________

EMPLOYER'S NAME_______________________________________________

EMPLOYER'S ADDRESS_____________________________________________

1. WHAT KIND OF A PET ARE YOU HERE TO ADOPT?

____DOG ____PUPPY ____CAT ____KITTEN ____OTHER(Specify)___________

2. WHY DO YOU WANT A PET?

_______________________________________________________________

WHAT TYPE OF BREED?____________________________________________

3. IS THIS YOUR FIRST EXPERIENCE WITH A PET? ____YES ____NO

4. WHAT OTHER PETS DO YOU CURRENTLY HAVE IN YOUR HOUSEHOLD?
(Please list type of animal and name)

_______________________________________________________________

5. ARE THEY ALTERED? _____YES _____NO

6. WHAT OTHER ANIMALS HAVE YOU OWNED IN THE PAST?

_______________________________________________________________

DO YOU STILL HAVE THEM? ____YES ____NO

IF NOT WHY?

_______________________________________________________________

7. WHO IS YOUR VETERINARIAN?

_______________________________________________________________

WHAT LAST NAME ARE THE VET RECORDS LISTED UNDER?_________________

8. DO YOU CURRENTLY LIVE IN A ___HOUSE    ___APARTMENT    ___CONDO ___MOBILE HOME    ___OTHER

9. DO YOU ____OWN    ____RENT?

10. IF YOU RENT, DOES YOUR LEASE ALLOW PETS? ___YES    ___NO    ___NOT SURE

11. IF YOU RENT, WHAT IS YOUR LANDLORD'S NAME?

_______________________________

12. HOW LONG HAVE YOU LIVED AT THE ABOVE ADDRESS?

________________________

13. HOW MANY PEOPLE LIVE IN YOUR HOUSEHOLD?

_______________________________

DO ALL THE ADULTS KNOW THAT YOU PLAN TO ADOPT? ___YES ___NO

IF THERE ARE CHILDREN IN THE HOUSEHOLD, WHAT ARE THERE AGES?

__________________

14. DO YOU OR ANYONE LIVING IN YOUR HOUSEHOLD HAVE ANY KNOWN ALLERGIES TO ANIMALS? ___YES ___NO

IF YES, TO WHAT KIND(S) OF ANIMALS AND HOW SEVERE IS THE ALLERGY?

____________________________________________________________________

15. WHO WILL BE RESPONSIBLE FOR THE CARE OF THIS PET?

_______________________

16. WHERE WILL THIS PET BE KEPT WHEN ALONE?

_________________________________

17. DO YOU PLAN ON SPAYING OR NEUTERING YOUR PET? ___YES    ___NO

18. AN AVERAGE LIFESPAN FOR A CAT OR DOG IS 10-15 YEARS. ARE YOU WILLING TO CARE FOR THIS ANIMAL FOR THE REST OF ITS LIFE? ___YES    ___NO

ARE YOU WILLING TO TAKE THIS ANIMAL WITH YOU IF YOU RELOCATE?
___YES     ___NO

19. HOW DID YOU HEAR ABOUT OUR ADOPTION SERVICE?

_______________________________

DOG ADOPTIONS ONLY

20. DO YOU HAVE A FENCED YARD? ___YES ___NO
IF YES, HOW HIGH?____________

21. DO YOU WANT THE DOG FOR A: (Check all that apply)

___COMPANION ___BREEDER ___GIFT ___WATCH DOG

___HUNTING DOG ___COMPANY FOR OTHER DOG

___OTHER (Please Explain _____________________________________)

22. DO YOU REALIZE YOU WILL PROBABLY HAVE TO HOUSETRAIN YOUR NEW PUPPY OR DOG?

___YES ___NO

23. ARE YOU FAMILIAR WITH THE LEASH AND LICENSING LAWS IN YOUR COMMUNITY?

___YES ___NO

24. WHAT WILL YOU DO IF YOUR DOG CHEWS FURNITURE OR SHOWS OTHER DESTRUCTIVE BEHAVIOR?

____________________________________________________________

25. ARE YOU FAMILIAR WITH CRATING? ____YES ____NO

26. IF YES, WHAT ARE YOUR FEELINGS ABOUT IT?

______________________________________________

27. DO YOU PLAN TO TAKE YOUR DOG TO OBEDIENCE TRAINING CLASSES?

___YES ___NO

28. HOW WILL YOU KEEP YOUR DOG CONFINED TO YOUR PROPERTY? (Check all that apply)

__IN HOUSE __KENNEL __FENCED YARD __ON CHAIN __GARAGE

__PATIO __ON LEASH __LOOSE ON PROPERTY

___OTHER (Please Explain _____________________________________)

CAT ADOPTIONS ONLY

29. DO YOU WANT THE CAT FOR A: (CHECK ALL THAT APPLY)

___COMPANION ___MOUSER ___BREEDER ___GIFT

___COMPANION FOR OTHER PET ______

OTHER (Please Explain _____________________________________)

30. WILL THIS CAT BE ALLOWED OUTDOORS? ___YES ___NO

IF YES, UNDER WHAT CIRCUMSTANCES? ________________________________

31. DO YOU PLAN ON DECLAWING? ___YES ___NO

32. WHAT WILL YOU DO IF YOUR CAT CLAWS FURNITURE OR SHOWS OTHER DESTRUCTIVE BEHAVIOR?

________________________________________________________________

PLEASE READ AND SIGN BELOW - THE APPLICATION WILL NOT BE PROCESSED WITHOUT A SIGNATURE

I CERTIFY THE ABOVE INFORMATION IS ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. I UNDERSTAND THAT THE DCSPCA HAS THE RIGHT TO RECLAIM THE ANIMAL IF ANY GIVEN INFORMATION IS FOUND TO BE FALSE. I AUTHORIZE THE RELEASE OF VETERINARIAN INFORMATION RELATED TO MY CURRENT AND PAST PETS.

X_____________________________________________________