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Adoption Application: Date: - Animal: - Case

This adoption application document collects information from potential adopters, including contact details, home and landlord information, details on care plans for the pet, experience with pets, veterinary plans, and an agreement to return the pet if unable to care for it long term. The applicant is asked about their reasons for adoption, living situation, vacation and emergency plans, daily care, who will be responsible, housing locations, veterinary financial plans, spay/neuter views, household members, interaction concerns, past pet history, lifetime commitment understanding, confinement plans (for dogs), exercise plans, and transport plans (for dogs). The application must be signed agreeing to bring the pet back to the shelter if needed and acknowledging there are no refund

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Aaron Puchalski
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43 views2 pages

Adoption Application: Date: - Animal: - Case

This adoption application document collects information from potential adopters, including contact details, home and landlord information, details on care plans for the pet, experience with pets, veterinary plans, and an agreement to return the pet if unable to care for it long term. The applicant is asked about their reasons for adoption, living situation, vacation and emergency plans, daily care, who will be responsible, housing locations, veterinary financial plans, spay/neuter views, household members, interaction concerns, past pet history, lifetime commitment understanding, confinement plans (for dogs), exercise plans, and transport plans (for dogs). The application must be signed agreeing to bring the pet back to the shelter if needed and acknowledging there are no refund

Uploaded by

Aaron Puchalski
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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ADOPTION APPLICATION

Date:_____________ Animal:_______________________ Case:______________

Name: ___________________________________________________________________

Home Phone: _______________Cell:________________ Email:______________________

Address: __________________________________________________________________

City, State, Zip: _____________________________________________________________

Reason(s) why you are considering adoption. Please be specific:_______________________________________

___________________________________________________________________________________________

I live in a:  HOUSE  APARTMENT  CONDO  MOBILE HOME Status:  OWN  RENT

Landlord’s Name:____________________________________ Phone:___________________________________

If you suddenly had to give up this pet for any reason, what would you do with this animal?______________
_________________________________________________________________________________________

What will happen to this pet when you go on vacation or in case of emergency?

How many hours a day will this pet be left alone?_________Where will it be kept?_____________________

Who, primarily, will be responsible for this pet? ________________

Where will this pet be kept during the day? ____________________;The Night?______________________

If your new pet were to become seriously injured ill or injured and needed expensive veterinary care, what would
you do?
_______________________________________________________________________________________

Who will be the veterinarian for this animal?_____________________________________________________

To feed, vaccinate, and provide medical care for this animal, what do expect to pay each year?____________

How do you feel about having this pet spayed or neutered?_______________Why?_____________________

Name all adults in household(over 18)____________________________________________________________

# of children(17 & under)_____ (list ages/names) ___________________________________________________

Does anyone in your household have allergies to animals?_________________________________________

What will you do if the new pet doesn’t get along with your present pet(s)?_____________________________

Have you ever had to turn an animal over to an animal shelter? ______If yes, please explain:______________
_______________________________________________________________________________________

Are you familiar with the animal control laws regarding licenses?__________;Leash Requirements?_________
Please provide the following information for all pets you currently own or have owned in the past five years
(cats and dogs):

NAME BREED AGE SEX SPAYED/ HOW LONG WHAT HAPPENED


NEUTERED? DID YOU OWN? TO THIS PET?

Are you aware that when you adopt an animal, you are taking responsibility for the lifetime of the animal, which may
be 20 years?______
Dogs Only
How will this dog be confined to your property?___________________________________________________
If you have a fenced yard, type of fence:____________________________Height:______________________

How will you exercise this dog?_______________________________________________________________

If you own a pick-up truck, will your dog ride in the back?___________________________________________

Cats Only
Do you plan to have your cat de-clawed?_________. Do you know there are other options?________________

By signing below, I certify that the information I have provided is true and that any misrepresentation of
facts may result in my losing adoption privileges with Clatsop County. Also by signing below I agree to bring
the animal back to the shelter if it can no longer remain with me. I also realize that there are NO REFUNDS
on adoptions.

-NOTE: THERE ARE NO REFUNDS-


This questionnaire will be reviewed by an adoption assistant before the adoption is approved. Thank you!

Signature Date_______________________________

OFFICE USE ONLY


Date Application Accepted:___________ Time:__________ Application Approved By:_________________

Home Inspection:__________________ Inspection Time/Date ________________Inspector_________________

Landlord Approval:___________________________ Vet Appointment Date:______________________

Notes:________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________

Clatsop County Animal Control Services, 1315 SE 19th, Warrenton, OR 97146 Phone: 503-861-7387 Fax: 503-861-0748

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