Columbia-Greene Humane Society/Spca

COLUMBIA-GREENE HUMANE SOCIETY/SPCA Adoption Application

Animal(s) Being Applied For: ______Cage #: ______Date: ______

Please list the first and last name of each adult living in the household, beginning with the intended PRIMARY CARETAKER(S) of the pet being applied for.

______

Are there children residing in the household? ______If yes, what ages? ______

Mailing Address: ______

Physical Address (If different from mailing) ______

Home Phone: ______Work Phone: ______

Cell Phone: ______Email Address: ______

Does anyone in the home have allergies?______If yes, what kind? ______

How would you describe the area you live in? (i.e., city, country, suburb, etc.):______

Please indicate the type of residence: □ Live in Owned Home. Owner Name/Number: ______

□ Live in Rented Home/Apart. Landlord Name/Number: ______

□ Live in Mobile Home. Lot Owner Name/Number: ______

PET HISTORY: Please list all pets, live or deceased, that were owned by anyone in the household in the past five years, EVEN IF THEY ARE NO LONGER IN THE HOUSEHOLD.

Name of Pet Age Breed/Type Spayed/Neut.? Still Have? Year Obtained

If any of the pets listed above are no longer in the household for any reason, please explain why. If they are deceased, please give the cause and date of passing:

______

SHELTER HISTORY: List ANY animals ever adopted from or surrendered to any animal shelter: Pet Name: Shelter Name: Date If a surrender, list reason:

______

VETERINARY HISTORY: Please list all veterinarians used for any current or previous pets in the household: Vet. Practice Name Phone # Patient Name(s) Last Seen Name of Listed Owner(s)

______

GENERAL QUESTIONS:

For Dogs:

Where do you plan on keeping the dog(s) during the day? ______At night? ______

How will you take/keep the dog outside? (i.e. leash, tether, kennel, fence, free range, etc.): ______

______For how long? ______

Will you be seeking professional training? ______

How many hours, on average, will the dog be left alone for? ______

For Cats:

Will the cat be strictly indoors, outdoors, or a combination of both? ______

Do you plan on declawing the cat? □ Yes □ No If yes, why? ______

REFERENCES: Please list three personal references that are available for us to speak with.

Name and Relationship: Phone Number: Alternate Number:

1. ______

2. ______

3. ______

PLEASE NOTE: By signing this adoption application, I am accepting all risks associated with handling animals during the adoption process. I also further attest that the information contained in this document is complete and TRUE. I realize that giving incomplete, misleading, or false information will result in being denied the privilege of adoption. I authorize my vet to release and discuss all veterinary records pertaining to any person or animal in my household to the Columbia-Greene Humane Society/SPCA.

Applicant Signature: ______Date: ______