Adoption Application

Animal you are interested in adopting
Adopt or Foster? *
Applicant's First Name
Applicant's Last Name
Street Address
City
State
Apartment Number (if applicable)
Zip Code
Phone Number Please use the following format 248-555-1212
Email Address Please enter correctly as this is the main way we will contact you
Alternate Phone Number
How did you find out about us?
Have you applied anywhere else for a pet?
If yes, where else have you applied for a pet?
Is this pet for you or someone else?
Do you own other pets at the current time?
If yes, please list their names, breeds, and ages.
Are all of your pets spayed/neutered/fixed?
Are your pets current on their vaccinations?
Have you ever turned your dog or cat into a shelter?
If yes, please explain?
Veterinarian's Name If you have never owned a pet please tell us where you would go.
Veterinarian's Address, City, State, and Zip Code Again if you have never owned a pet please list where you would go
Veterinarian's Phone Number
Are you familiar with heartworm and heartworm prevention?
If you have pets, will they adjust to a new pet in the house?
Please check the main reason you plan to adopt a pet:
If you answered "other" above, please explain here:
Please describe in detail the pet you are looking for.
Do you own or rent your home?
Please select your current residence type.
If you answered "other" above, please explain here:
If you rent, does your landlord and lease allow pets?
Including yourself, how many people live in your household?
Please list the ages & relationship of those who live in your home.
Is everyone in your household aware that you are planning to adopt a pet?
Does anyone in your household have allergies to dogs/cats?
Employment Status
If you chose "other" above, please explain:
On average, how many hours per day will your pet be left alone?
Will this pet be predominantly living inside, outside, or both?
Please provide a description of this pet's living conditions.
Do you have a completely fenced-in yard? If so, what kind of fence?
If you answered "other" above, please explain:
If you do not have a fenced yard, how will you let the animal out?
Are there times when the animal will be tied/chained up?
If yes, when will they be tied/chained up?
Where will the animal sleep?
If you answered "other" above, please explain:
How will you handle housebreaking?
How will you handle destructive behavior?
Will you keep the animal up-to-date on vaccinations and heartworm preventative?
If no, please explain:
Are you willing and able to exercise the dog on a regular basis?
If yes, what is the method of exercise?
If you answered "other" above, please explain:
For what reason(s) would you consider returning/giving up the animal?
What would you do with your animal if you had to move?
If you answered "other" above, please explain:
Are you willing to take responsibility for this animal for the next 10-20 years?
If no, please explain:
Will you allow us to perform home checks?
Have you or anybody in your household been charged or investigated with a criminal felony in regards to animal neglect or cruelty? *
Have you or anybody in your household been founded or investigated with regard to child neglect or abuse? *
Clay County Animal Control and Shelter does not support the declawing of the cats/kittens. Will you be willing to not have this procedure on the pet that you adopt from our shelter? *
If this pet is not spayed/neutered at the time of adoption, are you willing to foster to adopt until the pet is spayed/neutered when the pet reaches 6 months of age, as per Illinois State Law? *
I have read the foregoing and certify that the answers I have given are complete, true and not misleading in any way. I am authorizing you to contact landlords, associations and veterinarians. You are also aware that we cannot guarantee the health and temperament of the animal.
Adopter Signature * Adopter Signature