SJRAS Adoption Questionnaire

#1 Animal Name of Interest (select one) select one
#2 Animal Name of Interest (select one)
First Name *
Last Name *
Street Address *
City *
State *
Zipcode *
Municipality * Most of the time this will be the same as your city, but can be different if you have a mailing address in the nearby major city but actually live in a smaller borough or township. (example: If you live in Hopewell Township but have a Bridgeton mailing address)
County *
Email Address *
Home Telephone
Mobile Telephone
Work Phone
Best Way to Reach You? *	Cell Home Work
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ABOUT YOUR FAMILY We welcome adopters who rent or live in an apartment or condo. We want to alert you that some landlords & management companies have size & breed restrictions, limits on number of pets, and/or require pet deposits or additional fees. We will need their contact information in order to verify there is no issue with the type/size of pet you wish to adopt.
Type of Housing *	Home Apartment Mobile Home Condo Dormitory
.
Do You *	Rent Own Live with Parents Other (explain below)
If You Selected "Other" Above Please Explain
If You Selected "Rent" Above, Name of Your Landlord/Mgmt Company
Your Landlord/Mgmt Co Phone Number
Tell Us About the Human Members of Your Household * (example - number of adults/senior/special needs individuals/young children, etc)
Are There Large Dogs in the Home? *
How Many?
Tell Us About The Large Dogs We're looking for info such as sex, age and breed for each of the large dogs.
Are There Small Dogs in the Home? *
How Many?
Tell Us About The Small Dogs We're looking for info such as sex, age and breed for each of the large dogs.
We Have One or More Cats *
We Have One or More Pocket Pets (ferrets/hamsters.etc) *
We Have One or More Pet Birds *
Dog Any of These Pets Have Special Requirements to Take into Consideration When Adding a New Pet to Your Home? Behavior or medical issues would be the most common issues.
We'll Explain This New Pet's Medical History & Behavioral History. Please Select Any Additional Topics You'd Like to Discuss: *
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To Help Us Find the Best Match for You Please Answer Questions as Honestly as Possible
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The Following Questions Are for Dogs Adoptions (skip this section if you are interested in adopting any pet except a dog)
What Will This Dogs Living Situation Be?	Will Be A House Pet & Live Inside With Family Will Live Primarily In The Basement or Garage Will Live Primarily Outside Other (explain below)
If Other Please Explain
When the Dog is Alone Inside the Home Will it Be	Loose Crated Gated In One Area
.
When the Dog is Outside Will it Be	Loose Tethered In a Kennel In a Fenced Yard
What Activities are You Hoping to do With This Dog? (select all that apply)
Do You Prefer a Dog That is (select all that apply)
If You Have Had Dogs Previously, Please List Their Dispositions (select all that apply)
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The Following Questions Are for Cat Adoptions (skip this section if you are interested in adopting any pet except a cat)
What Will This Cats Living Situation Be?	A House Pet Living Inside with Family Will Be Primarily in the House But Will Have Access to Outdoors While Tethered Will Be Primarily in the House But Will Have Access to Outdoors Loose Cat Will Live Outside
If You Have Had Cats Previously, Please List Their Dispositions (select all that apply)
Some Cats May Become Stressed by the Transition Into a New Home. How Long Are You Willing to Give the Cat to Adjust?	One Week Two Weeks One Month Six Months As Long As It Takes
Are You Planning to Declaw This Cat
If You Are Planning To Declaw, Why?
Now All the Legal Mumbo Jumbo Our Lawyers Tell Us We Have to Include
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We reserve the right to refuse any adoption. A refusal may not indicate any shortcomings on the part of the prospective adopter, but perhaps reflects that a particular pet may not do well in the circumstances offered. Our years of experience and information from national organizations such as HSUS and AHA are our guide in arranging a successful adoption.
By hitting the SUBMIT button below I certify that I am at least 18 years of age. I also certify that all information given by me in this application is true & complete. I further understand that any falsified information that I give will terminate action on the adoption process. I certify that I understand that SJRAS will NOT be able to contact me to update the status of my adoption. I authorize release/disclosure of records and/or other information concerning all of the above inquiries (including but not limited to employment, tenancy & veterinary records.) I am aware that in order to follow up with my adoption I must contact the SJRAS office within 24-48 hours after submitting this application.
In order to avoid confusion or misunderstanding we ask that you read the Adoption Process & Illness Information. This document will open in a separate window so as to not interrupt your completing the questionnaire.
I understand that I should read & understand the ADOPTION PROCESS & ILLNESS Information * I understand that I should read & understand the ADOPTION PROCESS & ILLNESS Information.
Finally, Please Tell Us Why You Are Adopting A Pet (select all that apply) *

	I don't like money savings offers & do not want to hear about events and other news at SJRAS. Please leave me out of future eNews mailings.
Signature (if on a compatible device)
<--------------------All Items Below This Line For SJRAS OFFICE STAFF USE ONLY----------------------->
ASM Complete Date: CC Complete Date: Tax Complete Date: O - - - - R - - - - -OTHER LL Ok'd Date: RestrictionsIndicated:
Processing Notes:
Date: Counselor: Session Notes:

SJRAS Adoption Questionnaire

ABOUT YOUR FAMILY

To Help Us Find the Best Match for You Please Answer Questions as Honestly as Possible

Now All the Legal Mumbo Jumbo Our Lawyers Tell Us We Have to Include