Adoption Application

Animal you are interested in adopting

Species(Dog,Cat,Etc)

*

In order to be considered as an adopter you must: Be 18 years of age or older, Have identification showing your present address, Have the knowledge and consent of your landlord (a Landlord Approval Form will be provided), Be able and willing to provide a loving, safe and peaceful environment for this pet, Be financially stable and willing to provide any necessary medical care. Pet ownership is a serious responsibility. The policy of this facility is to ensure that each person who adopts a pet is aware of the responsibility and is capable and willing to accept that responsibility morally, physically and financially. The following questionnaire has been designed to aid both you and our facility in deciding if you and/or your family are adequately prepared to assume the responsibility of pet ownership. Please be sure to ANSWER ALL QUESTIONS and feel free to add your own comments.

Applicant's First Name

Applicant's Last Name

Street Address

City

State

Apartment Number (if applicable)

Zip Code

Phone Number

Email Address

Alternate Phone Number

Date of Birth

What is the best way to contact you?

Occupation

Spouse/Significant Other Occupation

Please list the name, age and relationship to yourself of each person currently living in your home (i.e.: Mary-15, daughter)

Does anyone living in your home have any known pet allergies?

Please select your current residence type.

Do you own or rent your home?

How long have you lived at this address?

If renting, is your name listed on the lease?

If you rent we will provide a Landlord Approval Form to be completed by your landlord prior to being considered as a completed application.

Do you plan to move within the next 3-6 months?

If yes, where?

Please check the main reason you plan to adopt a pet:

Do all adults in your household know your plan to adopt?

Comments

Have your children ever been around dogs and/or cats?

Comments

Do your current pets get along with other animals?

Comments

Will this pet be predominantly living inside, outside, or both?

If adopting a cat do you understand city ordinances regarding keeping cats indoors?

Comments

On average, how many hours per day will your pet be left alone?

Do you have a completely fenced-in yard? If so, what kind of fence?

Do you have locks and/or latches on all your gates?

If no, why not?

If adopting a dog, will you ever have to tie or chain it up in your yard?

If yes, why?

Where do your pets stay if/when you travel?

Please list name, type, age, gender and if the pet is spayed or neutered of all of your current animals .

Please list name, type, age, gender and if pet was spayed or neutered of all animals you no longer have (within the last 5 years) and what happened to the animal .

Are your companion animals currently spayed/neutered?

If no, why not?

Are your animals current on all vaccinations?

Can you provide proof?

If no, why not?

Name of your current or last veterinarian?

May we contact this veterinarian as a reference?

If no, why not?

For what reason(s) would you consider returning/giving up the animal?

What would you do with your pet if you could not keep it for one of the reasons listed/stated above?

Have you ever surrendered a pet to a shelter/pound?

If yes, why?

Would you allow Rock Springs Animal Control to stop by periodically to check on the animal after adoption or to call to check on the animal’s welfare?

If no, why not?

Please provide the name and phone number for three personal references

Pets are an investment of your time and money. Are you prepared to provide medical care, grooming, proper diet, shelter and regular exercise to your pet?

How did you hear about Rock Springs Animal Control?

Is there anything else you would like to tell us that you think would be important when considering your application?

Many factors determine which applicant will be matched with a particular pet. If you are not able to adopt a pet, it does not mean that you are not considered a good pet owner or that your home is not acceptable. Our goal is to place all animals into homes that will best suit the animal’s individual needs.

I have completed this application truthfully and fully understand the adoption process. *