First Choice *

Second Choice

Applicant Name *

Co-Applicant

Applicant Phone Number *

Applicant Email Address *

Street Address *

City *

State Alabama Arkanas Arizona California Colorado Connecticut Delaware Florida Georgia Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming *

Zipcode *

Have you ever adopted a pet before? Yes No *

If yes, when?

Do you still have the pet? Yes No

Was the pet altered? Yes No

Was the pet crate trained? Yes No

Please fill out the following information pertaining to any pets you currently have or have had in the last 16 years.

Name of Pet 1

Pet 1 Type/Breed of Animal Dog Cat

Pet 1 was a... Male Female

Age of Pet 1

Was Pet 1 spayed or neutered? Yes No

How long was pet 1 in your care?

Pet 1 was kept... Inside Outside Inside & Outside

Name of Pet 2

Pet 2 Type/Breed of Animal Dog Cat

Pet 2 was a... Male Female

Age of Pet 2

Was Pet 2 spayed or neutered? Yes No

How long was pet 2 in your care?

Pet 2 was kept... Inside Outside Inside & Outside

Do you have other pets? If so, using the above as a guide, please list them here.

Name of vet clinic

Name of veterinarian

Veterinarian Phone Number

Have you been guardian to any animals that were... Killed by moving vehicle Given away Lost Stolen

If you answered yes to any of the questions above, please explain.

Do you own or rent your home? Own Rent *

Do you live in... House Condo Apartment With parents/roommates *

If you rent, name of landlord

Phone number of landlord

Does anyone in the household have allergies to pet dander/hair/saliva? Yes No *

Why do you want to adopt this particular pet? *

Is someone home during the day? Yes No *

If so, who?

How many hours will your pet be alone? *

How many hours will you spend with your pet? *

Where will you keep the pet? *

Where will you keep pet at night? *

Where will you keep your pet when traveling? *

What do you feed your past or current pets?

Do you have a boarding facility that you use? If so, please provide name, address, contact information [phone, website, email].

Because it is very stressful for a pet to go from home to home, we hope to place each one in a caring home for the rest of its life, which could be up to 20 years. Are you prepared for this commitment? Yes No *

What will happen to the pet if you move? *

What if you move to a place that doesn't allow pets? *

This pet may take several weeks or months to fully adjust to you and your home. How would you ease the adjustment? *

Other pets are current on... (check all that apply) Vaccinations Heartworm Prevention Flea Preventative

What kind of behavior do you find unaccapetable? *

How would you handle these behaviors? *

Do you believe in spaying/neutering? Yes No *

How much do you think it will cost per year to vaccinate, feed and care for this pet? *

What would cause you to return this pet to the Alabama SPCA? *

Under what conditions would you consider euthanasia? *

Which of these subjects would you be interested in learning more about? Feeding/Nutrition Litter Training Scratching/Declawing Upper Respiratory Infection Grooming/Fleas Feline Leukemia/Feline Aids Household Dangers Urinary tract problems Introducing new pet to other pets Introducing new pet to children Outside dangers

Have any other questions or comments?

Reference 1 Name *

Reference 1 Email

Reference 1 Phone Number *

Reference 2 Name *

Reference 2 Email

Reference 2 Phone Number *

First Choice

Second Choice

Applicant Name

Co-Applicant

Applicant Phone Number

Applicant Email Address

Street Address

City

State

Zipcode

Number of persons in household

Number of adults

Number of teens/seniors

Number of infants/toddlers

Have you ever adopted a pet before?

If yes, when?

Do you still have the pet?

Was the pet altered?

Was the pet crate trained?

Name of Pet 1

Pet 1 Type/Breed of Animal

Pet 1 was a...

Age of Pet 1

Was Pet 1 spayed or neutered?

How long was pet 1 in your care?

Pet 1 was kept...

Name of Pet 2

Pet 2 Type/Breed of Animal

Pet 2 was a...

Age of Pet 2

Was Pet 2 spayed or neutered?

How long was pet 2 in your care?

Pet 2 was kept...

Do you have other pets? If so, using the above as a guide, please list them here.

Name of vet clinic

Name of veterinarian

Veterinarian Phone Number

Have you been guardian to any animals that were...

If you answered yes to any of the questions above, please explain.

Do you own or rent your home?

Do you live in...

If you rent, name of landlord

Phone number of landlord

Does anyone in the household have allergies to pet dander/hair/saliva?

Why do you want to adopt this particular pet?

Is someone home during the day?

If so, who?

How many hours will your pet be alone?

How many hours will you spend with your pet?

Where will you keep the pet?

Where will you keep pet at night?

Where will you keep your pet when traveling?

What do you feed your past or current pets?

Do you have a boarding facility that you use? If so, please provide name, address, contact information [phone, website, email].

Because it is very stressful for a pet to go from home to home, we hope to place each one in a caring home for the rest of its life, which could be up to 20 years. Are you prepared for this commitment?

What will happen to the pet if you move?

What if you move to a place that doesn't allow pets?

This pet may take several weeks or months to fully adjust to you and your home. How would you ease the adjustment?

Other pets are current on... (check all that apply)

What kind of behavior do you find unaccapetable?

How would you handle these behaviors?

Do you believe in spaying/neutering?

How much do you think it will cost per year to vaccinate, feed and care for this pet?

What would cause you to return this pet to the Alabama SPCA?

Under what conditions would you consider euthanasia?

Which of these subjects would you be interested in learning more about?

Have any other questions or comments?

Reference 1 Name

Reference 1 Email

Reference 2 Name

Reference 2 Email

Reference 2 Phone Number

Please check this box to verify that the above information is correct. *

By my/our signature on this document, I/we certify that the above statements about me/us and my/our history with companion animals are true and correct. I/We understand that the Alabama SPCA reserves the right to refuse any applicant based on its adoption rules and guidelines. Any misrepresentation of fact may result in my/our application being rejected and any and all fees shall be forfeited.

My signature on this document also permits my present or previous Veterinarian or Animal Hospital to release requested information to an Alabama SPCA volunteer/adoption agent regarding my current or previously-owned pets for the purpose of considering my application. I am/We are aware that prior to placement of a pet from the Alabama SPCA, my currently-owned pets, for their protection, must be up to date on needed vaccinations including: rabies, distemper shots, heartworm prevention and in some cases feline leukemia and feline aids tests.

Check this box to verify that you have read, understood, and accept the conditions above *

If you accept the conditions type your full name here *

Today's Date *