South Plains SPCA Canines Adoption Application | 2013

Dog's Name:____________________________ Breed:_________________________________ Microchip #:____________________________ Sex:_____________ Age:_____________ Other:____________

South Plains SPCA Adoption Application for a Dog/Puppy

(Applicants must be 18 or older) Applicant's Name Co-Applicant's Name Applicant's cell phone Applicant's email Relationship Spouse Parent/Guardian to co-applicant Address Age Age Home phone Home phone

Co-Applicant's cell phone Co-Applicant's email Roommate City Significant Other State Other Zip

Mailing address (if different from above):

If you had to move with this dog, what would you do?

How long at your current address?

If you have lived at your current address less than one year, please list your previous address:

City

State

Zip

Do you:

Own

Rent

Live with relatives Apt. Phone

If with relatives, who is the homeowner? Condo Mobile Home Best time to call?

Do you live in a: House Landlord/Complex Name Applicant's Employer

Townhouse

Co-Applicant's Employer

If unemployed, please list your source of income: How many adults live in the household? How many children live in the household? (please include children's ages)

Ages of other children who will frequently come in contact with the adopted dog (grandchildren, neighbors, etc). Please list other adults residing in the househould (other than applicant and co-applicant)and relationship to you. 1____________________________________ Relationship:____________________________________ 2____________________________________ Relationship:____________________________________ 3____________________________________ Relationship:____________________________________ 4____________________________________ Relationship:____________________________________

Form 3 - Version January 5, 2013

South Plains SPCA Canines Adoption Application | 2013

Do any of the above adults have animals living in or frequently visiting the home? Yes No Does any member of your household suffer from allergies or asthma related to animals? Yes No Why do you wish to adopt this animal? (check all that apply) Companion Gift Guard dog Watch dog For child For my other pet Who are you adopting this dog for? Yourself Relative Child Significant Other

If yes, please elaborate:

If yes, who and to what kind of animals?

To breed Personal protection Other___________________________

Friend Pet Other____________________

Is anyone home during the day? Yes No If yes, who? On average, how many hours per day would this animal be alone? ___________

Who will be responsible for the primary care of this pet?

Are you willing to take responsibility for this dog for the next 10-15 years? Yes No Dog Experience First time dog owner Had family dog when growing up Knowledgeable and experienced

If No, why not?

Have had one or two dogs

Are you familiar with the activity level and habits of this breed/mix? Yes No

The last time I owned a dog was: I own a dog now Within the last year 2-4 years ago 5-10 years ago More than 10 years ago If yes, please explain.

What attracted you to this dog?

What method do you plan on using for housebreaking? (please consider than an already housebroken animal may have accidents and/or need a refresher course after being adopted.

Are you familiar with crate training? Yes No

If yes, are you willing to crate train? Yes No

If you are not familiar, would you like more information about crate training? Yes No

If adopting a puppy, at what age do you think a puppy should be housebroken?

Form 3 - Version January 5, 2013

South Plains SPCA Canines Adoption Application | 2013

How much time are you willing to allow for the animal to become adjusted to your home? Are you willing to take this dog to obedience class or a private trainer? Yes No Have you ever taken a puppy/dog to an obedience training class or worked with a private trainer? Yes No If yes, what was involved in the training?

How would you describe the activity level of your household? High, always on the go Low, relaxing Normal, go to work and come home Active, sports and outdoor activities Other:_______________________________ The South Plains SPCA requires that all animals adopted from us be spayed or neutered. How do you feel about this? How will you confine your new dog to your property? Do you have a fenced yard? Yes No If yes, how tall is the fence? What type of fence is it?

If there is no fenced in area, how will the dog be exercised or taken out for bathroom breaks?

This dog will be:

Indoors only

In/Out

Outdoors only

Don't know yet

Where will the dog be kept during the day? Where will the dog be kept at night? Where will the dog sleep?

What do you consider a good/valid reason for you to give up this dog?

What do you plan on doing with this dog while you are on vacation?

What do you think are the most important responsibilites of owning a dog?

What preventative measures will you take to keep this dog from getting lost?

If this animal does get lost, what will you do to find it?

Form 3 - Version January 5, 2013

South Plains SPCA Canines Adoption Application | 2013

Please list the pets you currently own and any other pets in the home. Pet's name Type of animal Sex Spayed/ Age Neutered? Yes No Yes No Yes No Yes No Yes No Yes No Kept indoors or outdoors? In Out Both In Out Both In Out Both In Out Both In Out Both In Out Both

M F M F M F M F M F M F If any pets are not spayed/neutered, why not?

Are your current pets up-to-date on vaccines If no, why not?

Yes

No

Veterinarian/Clinic name:

Please list the pets you have owned in the last 10 years. Pet's name Spayed/or Age Kept indoors or Neutered? outdoors? M F Yes No In Out Both M F Yes No In Out Both M F Yes No In Out Both M F Yes No In Out Both M F Yes No In Out Both M F Yes No In Out Both Have you ever adopted an animal from any shelter or rescue in the past? Yes If yes, when? Where is the animal now? Have you ever brought an animal, other than a stray to any shelter in the past? If yes, please explain (be specific as to when, which shelter, and why.) Yes Type of animal Sex Where is it now?

No

No

Would you permit an authorized agent of the South Plains SPCA to inspect your home and the premises where this dog will be kept? Yes No If no, why not?

How did you hear about us?

Form 3 - Version January 5, 2013

South Plains SPCA Canines Adoption Application | 2013

Please list two references. Name Home Phone

Address

City

State

Zip Code

Relationship: Name Home Phone

Address

City

State

Zip Code

Relationship: We are here to facilitate a successful union with your pet. Please tell us which of these subjects you would like to learn more about: housetraining barking obedience training crate training grooming canine rivalry feeding chewing heartworm/flea/tick preventative vaccinations introducing your current pet to your new pet other _______________ I need help choosing a veterinarian __________I certify that all information contained in this application it true, and I understand that false information may void this application. I also certify that neither I, nor anyone in our household has every been convicted of animal cruelty, neglect, or abandonment. _________ If I do not comply with this adoption contract/terms and conditions, I understand charges will be filed against me by the SPSPCA.
THE SOUTH PLAINS SPCA RESERVES THE RIGHT TO DECLINE ADOPTION APPLICATIONS

Applicant Signature:_____________________________________________ Date: _________________ Co-Applicant Signature:___________________________________________ Date: _________________

Form 3 - Version January 5, 2013