01 Adoption Application

East Providence Animal Control Center

FOR STAFF USE	Staff member processesing:
Notes:	SCORE:

APPLICATION STATUS:	APPROVED	PENDING(date)	DENIED(reason)

401-435-7675

62 Commercial Way
East Providence, RI 02914

Adoption Application

Please fill out all lines that have an *

If you have any questions please email:
ebarlow@eastprovidenceri.gov

Animal you are interested in adopting *
Applicant's First Name *
Applicant's Last Name *
Street Address *
City *
State *
Apartment Number (if applicable)
Zip Code *
Home Phone Number
Cell Phone Number *
Email Address *
Date of Birth *
Drivers License Number *

1. Are you, or is a member of your immediate family (mother, father, sibling, spouse, child), an employee of the City of East Providence? (hereinafter the City) *
If 'Yes,' who is an employee of the City? *

How did you find out about us?
2. Is this pet for you or someone else? *
Who? Name/relation: *

3. Do you own other pets? *
If yes, please list their species, names, breeds, and ages. *
4. Are all of your pets spayed/neutered/fixed? *
5. Are all cats, dogs or ferrets currently rabies vaccinated? *

6. How many pets have you owned in the last five years?
What happened to them? *
7. Are all of your pets' vaccinations current?
8. Have you ever turned your dog or cat into a shelter? *
If yes, please explain? *

9. Veterinarian's Name *
Veterinarian's Address, City, State, and Zip Code
Veterinarian's Phone Number *

10. Do you own or rent your home? *
Please select your current residence type.
If you answered "other" above, please explain here: *
11. How long have you lived at this address?
12. Does your landlord/property-owner allow pets? *
Landlord/property-owner's name *
Landlord's phone number *

13. Including yourself, how many people live in your household?
14. Do any children live in the home? *
Please list the ages & relationship of those who live in your home.
15. Is everyone in your household aware that you are planning to adopt a pet?
16. Does anyone in your household have allergies to any pets? *
If, Yes, which types of animals are they allergic to? *
17. Will you be able to provide food, supplies, and veterinary care as required for this pet? *
18a. Will this pet be predominantly living inside, outside, or both? *
18b. Explain specifically where the pet will reside (whole house, single room, crate, kennel, garage, tethered outside, barn cat, etc) *

Are you adopting a cat?
19. Do you plan on having the cat declawed? *
20. Have you ever had a cat declawed or a dog devocalized? *
If yes, why was the procedure sought? *
Where will your new cat be staying? *
If 'other,' explain. *

21. On average, how many hours per day will your pet be left alone? *
22. When the pet is left alone, where will it be kept? *
If 'other' explain. *
23. Do you have a completely fenced-in yard? *
What type of fence do you have? *
What's the fence's height? *

24. Have you ever had contact with Animal Control for a pet you owned in the past? *
25. If 'Yes,' give an explanation of the previous contact with Animal Control, approximately when it occurred, and in which City or Town. *

26. Have you ever been convicted of abuse or neglect of a child or animal? *
If yes, please explain: *

*	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 EP Animal Control to contact landlords, references, associations, veterinarians, and otherwise authorize an investigation into my eligibility to adopt, including a criminal background check. You are also aware that we cannot guarantee the health and temperament of the animal. Additionally, I affirm that I have provided accurate information above as to my status as an employee of the City or an immediate relative of an employee of the City.
Signature *