Adoption Application

Animal you are interested in adopting
Date *
Applicant's First Name *
Applicant's Last Name *
Street Address *
City *
State *
Apartment Number (if applicable)
Zip Code *
Email Address * Please enter correctly as this is the main way we will contact you
Home Phone Number
Cell Phone Number *
Place of Employment
How did you find out about us?
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?
How many pets have you owned in the last 5-10 years?
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? *
Do you own or rent your home? *
Please select your current residence type.
If you answered "other" above, please explain here:
How long have you lived at this address?
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.
Does anyone in your household have allergies to dogs/cats?
Employment Status
On average, how many hours per day will your pet be left alone?
Will this pet be predominantly living inside, outside, or both?
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?
Where will the animal sleep?
If you answered "other" above, please explain:
How will you handle housebreaking?
Will you keep the animal up-to-date on vaccinations and heartworm preventative? *
If no, please explain:
Have you ever been convicted of abuse or neglect of a child or animal?
If yes, please explain:
What arrangements will you make for the care of your pets in case of an emergency?
If you answered "other" above, please explain:
Will you allow us to perform home checks?
The Medina County SPCA believes that there are risks associated with declawing and will not adopt based on that belief. Do you consent? * Declawing increases the risk of arthritis early in life and litter box problems due to pain.
Declaw Question * Do you plan on declawing this cat? Please Note: Medina County SPCA prohibits elective declawing cats. Declawing is an amputation that caused pain, long-term behavioral issues, and mobility problems. Adopters must agree not to declaw. This aligns with NACA, AAHA, AVMA, ASPCA, peer shelters, and it sets expectations upfront.
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. *