Dog Adoption Application

I am interested in adopting (name of dog - 1st Choice):

I am interested in adopting (name of dog - 2nd Choice):

OR (if you do not see a particular pet you are interested in at this time)

I am looking for my new best friend that fits this general description (i.e. size, gender, age, etc):

First Name: *

Last Name: *

*

Please check this box to verify that you are 21 years or older.

Email: *

Main Phone #: *

STREET Address (AND Apt # If Applicable): *

City: *

State: *

Zip Code: *

Employer: *

What hours do you work?: *

I live in: *

House
Apartment

Do you own or rent? *

Own
Rent

If renting, please provide apartment complex name / landlord name and phone #:

List names and ages of all people living in the household: *

List names and ages of any children visiting on a regular basis: *

Who will be responsible for caring for this animal? *

Do you have the consent of all family members to adopt a pet? *

Yes
No

Is anyone in your home allergic to pets? *

Yes
No

Have you ever adopted an animal before? *

Yes
No

If Yes, where have you adopted from?

Have you ever given up an animal for adoption? *

Yes
No

If Yes, why?

Where will your pet be kept when no one is home? *

Where will your pet sleep? *

Will your pet be crated? *

Yes
No

Do you have a totally fenced yard? *

Yes
No

If Yes, what type and height of fence?

Do you have a pool? *

Yes
No

Please choose ALL behaviors you are NOT willing to work through: *

CURRENTLY OWNED PETS

Do you currently own any pets? *

Yes
No

CURRENT PET #1 (If Applicable):

Dog or Cat?

Dog
Cat

Pet's Name, Breed, AND Age:

Sex:

Male (Intact)
Female (Intact)
Male (Neutered)
Female (Spayed)

If not neutered or spayed, reason why?

Length of Ownership?

If pet is a cat, is he/she declawed?

Yes
No

% of time indoors:

CURRENT PET #2 (If Applicable):

Dog or Cat?

Dog
Cat

Pet's Name, Breed, AND Age:

Sex:

Male (Intact)
Female (Intact)
Male (Neutered)
Female (Spayed)

If not neutered or spayed, reason why?

Length of Ownership?

If pet is a cat, is he/she declawed?

Yes
No

% of time indoors:

Please tell us about your other CURRENT pets (If Applicable):

(Breed, Size, Age, AND Sex)

PREVIOUSLY OWNED PETS

Have you previously owned any pets? *

Yes
No

PLEASE TELL US ABOUT PREVIOUSLY OWNED PET #1 (If Applicable):

Dog or Cat?

Dog
Cat

Pet's Name, Breed, AND Age:

Sex:

Male (Intact)
Female (Intact)
Male (Neutered)
Female (Spayed)

If not neutered or spayed, reason why?

Length of Ownership?

If pet was a cat, was he/she declawed?

Yes
No

% of time indoors:

PLEASE TELL US ABOUT PREVIOUSLY OWNED PET #2 (If Applicable):

Dog or Cat?

Dog
Cat

Pet's Name, Breed, AND Age:

Sex:

Male (Intact)
Female (Intact)
Male (Neutered)
Female (Spayed)

If not neutered or spayed, reason why?

Length of Ownership?

If this pet was a cat, was he/she declawed?

Yes
No

% of time indoors:

Please tell us about your other PREVIOUS pets (If Applicable):

(Breed, Size, Age, AND Sex)

VETERINARIAN INFORMATION

Names and numbers of current and previous veterinarians: *

Under what person's name(s) are the vet records listed? *

Are your pets currently on heartworm prevention? *

Yes
No
I have no current pets

If Yes, what brand?

Have you ever lost a pet or had a pet die at an early age? *

Yes
No

If answered Yes to the above, please describe the circumstances.

How did you find out about us? *

ADOPTION CONTRACT

1) I agree that I must comply with the following requirements and that failure to do so may result in the animal being reclaimed by the SPCA of East Texas.

2) I agree to return this animal to the SPCA of East Texas should I become unable to keep him or her for any reason.

3) I understand that my new pet has been given a clean bill of health. by a veterinarian. I further understand that the SPCA of East Texas cannot guarantee the future health of my adopted animal. I understand and agree that, if my pet should develop a serious illness, I am responsible from this date forward.

4) I understand and agree to have my pet vaccinated annually for rabies and distemper/parvo according to local ordinances. I further understand that my pet must be spayed/neutered if not already. I agree to keep my new pet in a properly fitted collar with an attached identification tag to be worn at all times.

5) I understand and agree to provide recommended amounts of food and fresh water to my pet on a daily basis. I further agree to provide veterinary care should it be needed in a prompt and responsible manner. I agree that my pet will be humanely confined in the manner required by the city/county ordinance. However, at no time will my pet be chained, tethered or tied up as a means of restraint.

6) I understand that heartworms are ultimately fatal for dogs. I agree to provide heartworm preventative for the duration of my pet's lifetime.

7) I understand and agree that the SPCA of East Texas may perform a follow up visit with me and my adopted pet. Should the care and conditions for this pet become unsafe or unhealthy, the SPCA of East Texas may reclaim ownership of this pet without refund.

8) In consideration for adopting a pet from the SPCA of East Texas, I hereby release, waive, discharge and covenant not to sue the SPCA of East Texas, its officers, servants, agents, volunteers and employees.

9) By signing this agreement, I acknowledge there are potential risks and hazards connected with adopting a pet. I hereby elect to voluntarily assume and accept all responsibility for adopting and caring for this animal from the SPCA of East Texas.

10) I am at least twenty-one (21) years of age and I have read the foregoing release, understand it, agreed to abide by it and am signing it voluntarily at my own free will.

11) I hereby certify that all information entered is true and I understand that false information my result in nullifying this adoption.

I agree that: *

I have read and accept the terms of the Adoption Contract.

I AGREE THAT: *

I AUTHORIZE MY VETERINARIAN TO RELEASE INFORMATION TO THE SPCA OF EAST TEXAS CONCERNING MY PERSONAL PETS.

IF USING A TOUCH SCREEN, please use finger to sign below. If needing to reset signature field, please hit the CLEAR button below.

*

If NOT using a touch screen, please initial in box below in lieu of signature.

Initials:

Please Type Name (First & Last): *

Date: *