SPSPCA Canine Adoption Application_2013

7/27/2019 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:____________________________________

Form 3 - Version January 5, 2013 1


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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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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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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






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?







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: _________________


Documents

SPSPCA Canine Adoption Application_2013