First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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County

Email*

Home Phone*

Work Phone
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Cell Phone*

Alt Email

Which animal(s) are you interested in? Please include 1st and 2nd choice if applicable.

Place of employment or if unemployed, for how long?*

Please tell us about your household. How many adults, children, teens, or seniors?*

Have you ever adopted an animal? If so, when/where did you adopt?*

Do you currently have any pets and/or have you owned any pets in the past 10 years? If so, please tell us about these pets. (Type/Breed/Name/Age/Spayed or Neutered/How long in your care/Inside or Outside pet?)

Are you current pets up to date on vaccines and preventatives?*

What's the name and number of your veterinarian?*

Have you ever been a guardian to any animals that were either killed by moving vehicles, given away, surrendered to shelter/rescue, and/or lost or stolen? If so, please explain.*

Do you own or rent your home?*

If you rent your home, please give name and number for your landlord.

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

Where will you keep your pet?*

How many hours per day will you spend with your pet?*

What do you feed your current or past pets?*

Do you have a fenced in area for your pet? *

Will you leash walk your dog?

It is very stressful for a pet to go from home to home. We hope to place each on 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 your pet if you move?

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

What kind of behavior do you find unacceptable? How would you handle these behaviors?*

Do you believe in spaying or neutering pets?*

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

Under what conditions would you consider euthanasia?*

Please provide two personal references whom we may contact. Include name, address, and phone numbers.*

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.

If you accept the conditions type your full name here*

Today's date*