spspca canine adoption application_2013
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South Plains SPCA Canines Adoption Application | 2013
Dog's Name:____________________________ Microchip #:____________________________
Breed:_________________________________ Sex:_____________ Age:_____________ Other:____________
South Plains SPCA
Adoption Application for a Dog/Puppy(Applicants must be 18 or older)
Applicant's Name Age Home phone
Co-Applicant's Name Age Home phone
Applicant's cell phone Co-Applicant's cell phone
Applicant's email Co-Applicant's email
Relationship Spouse Parent/Guardian Roommate Significant Other Other
to co-applicant
Address City State Zip
Mailing address (if different from above):
If you had to move with this dog, what would you do? How long at your current address?
If you have lived at your current address less than one City State Zip
year, please list your previous address:
Do you: Own Rent Live with relatives If with relatives, who is the homeowner?
Do you live in a: House Townhouse Apt. Condo Mobile Home
Landlord/Complex Name Phone Best time to call?
Applicant's Employer Co-Applicant's Employer
If unemployed, please list your source of income:
How many adults live in the household? How many children live in the household?
(please include children's ages)
Ages of other children who will frequently come in contact with the adopted dog (grandchildren, neighbors, etc).
Please list other adults residing in the househould (other than applicant and co-applicant)and relationship to you.
1____________________________________ Relationship:____________________________________
2____________________________________ Relationship:____________________________________
3____________________________________ Relationship:____________________________________
4____________________________________ Relationship:____________________________________
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South Plains SPCA Canines Adoption Application | 2013
Do any of the above adults have animals living in or If yes, please elaborate:
frequently visiting the home? Yes No
Does any member of your household suffer from allergies If yes, who and to what kind of animals?or asthma related to animals? Yes No
Why do you wish to adopt this animal? (check all that apply)
Companion Gift Guard dog To breed Personal protection
Watch dog For child For my other pet Other___________________________
Who are you adopting this dog for?
Yourself Relative Friend Pet
Child Significant Other Other____________________
Is anyone home during the day? Yes No If yes, who?
On average, how many hours per day would this animal be alone? ___________ Who will be responsible forthe primary care of this pet?
Are you willing to take responsibility for this dog for the next If No, why not?
10-15 years? Yes No
Dog Experience The last time I owned a dog was:
First time dog owner Have had one or two dogs I own a dog now Within the last year
Had family dog when growing up 2-4 years ago 5-10 years ago
Knowledgeable and experienced More than 10
years ago
Are you familiar with the activity level and habits of this If yes, please explain.breed/mix? Yes No
What attracted you to this dog?
What method do you plan on using for housebreaking? (please consider than an already housebroken animal may
have accidents and/or need a refresher course after being adopted.
Are you familiar with crate training? If yes, are you willing to crate train? If you are not familiar, would youlike more information about
Yes No Yes No crate training? Yes No
If adopting a puppy, at what age do you think a puppy should be housebroken?
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South Plains SPCA Canines Adoption Application | 2013
How much time are you willing to allow for the animal to become adjusted to your home?
Are you willing to take this dog to Have you ever taken a puppy/dog to an If yes, what was involved in the
obedience class or a private obedience training class or worked with a training?
trainer? Yes No private trainer? Yes No
How would you describe the activity level of your household?
High, always on the go Low, relaxing Normal, go to work and come home
Active, sports and outdoor activities Other:_______________________________
The South Plains SPCA requires that all animals adopted from us be spayed or neutered.
How do you feel about this?
How will you confine your new dog to your property?
Do you have a fenced yard? If yes, how tall is the fence? What type of fence is it?Yes No
If there is no fenced in area, how will the dog be exercised or taken out for bathroom breaks?
This dog will be: Indoors only In/Out Outdoors only Don't know yet
Where will the dog be kept during the day?
Where will the dog be kept at night?
Where will the dog sleep?
What do you consider a good/valid reason for you to give up this dog?
What do you plan on doing with this dog while you are on vacation?
What do you think are the most important responsibilites of owning a dog?
What preventative measures will you take to keep this dog If this animal does get lost, what will you do tofrom getting lost? find it?
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South Plains SPCA Canines Adoption Application | 2013
Please list the pets you currently own and any other pets in the home.
Pet's name Type of Sex Spayed/ Age Kept indoors or
animal Neutered? outdoors?
M F Yes No In Out Both
M F Yes No In Out Both
M F Yes No In Out Both
M F Yes No In Out Both
M F Yes No In Out Both
M F Yes No In Out Both
If any pets are not spayed/neutered, why not?
Are your current pets up-to-date on vaccines Yes No
If no, why not?
Veterinarian/Clinic name:
Please list the pets you have owned in the last 10 years.
Pet's name Type of Sex Spayed/or Age Kept indoors or Where is it now?
animal Neutered? outdoors?
M F Yes No In Out Both
M F Yes No In Out Both
M F Yes No In Out Both
M F Yes No In Out Both
M F Yes No In Out Both
M F Yes No In Out Both
Have you ever adopted an animal from any shelter or rescue in the past? Yes NoIf yes, when? Where is the animal now?
Have you ever brought an animal, other than a stray to any shelter in the past? Yes No
If yes, please explain (be specific as to when, which shelter, and why.)
Would you permit an authorized agent of the South Plains SPCA to inspect your home and
the premises where this dog will be kept? Yes No
If no, why not?
How did you hear about us?
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Please list two references.
Name Home Phone
Address City State Zip Code
Relationship:
Name Home Phone
Address City State Zip Code
Relationship:
We are here to facilitate a successful union with your pet. Please tell us which of these subjects
you would like to learn more about:
housetraining barking obedience training
crate training grooming canine rivalry
feeding chewing heartworm/flea/tick preventative
vaccinations introducing your current pet to your new pet other _______________
I need help choosing a veterinarian
__________I certify that all information contained in this application it true, and I understand that false information
may void this application. I also certify that neither I, nor anyone in our household has every been convicted of
animal cruelty, neglect, or abandonment._________ If I do not comply with this adoption contract/terms and conditions, I understand charges will be
filed against me by the SPSPCA.
THE SOUTH PLAINS SPCA RESERVES THE RIGHT TO DECLINE ADOPTION APPLICATIONS
Applicant Signature:_____________________________________________ Date: _________________
Co-Applicant Signature:___________________________________________ Date: _________________
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