Adoption Application
Are you interested in a listed animal?
CHLOE (Cat - 20-148)
DUCHESS (Cat - 20-191)
JESSIE (Cat - 20-147)
JINX (Cat - 20-217)
LUNA (Cat - 20-218)
MINNIE (Cat - 20-133)
MOLLY (Cat - 19-187)
MUFASA (Cat - 21-002)
OLIVER (Cat - 20-127)
OLLY (Cat - 21-001)
POLAR (Cat - 20-105)
RUBY (Cat - 20-064)
SALLY (Cat - 20-011)
SNOWY (Cat - 20-109)
SPICE (Cat - 20-180)
STAR (Cat - 20-219)
SUGAR (Cat - 20-206)
TIGGY (Cat - 20-220)
ZIGGY (Cat - 20-173)
If no, what kind of animal are you interested in?
Applicant's First Name
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Applicant's Last Name
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Street Address
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City
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Province
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Apartment Number (if applicable)
Postal Code
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Phone Number
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Email Address
Alternate Phone Number
Date of Birth
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Have you applied anywhere else for a pet?
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No
Yes
If yes, where else have you applied for a pet?
Is this pet for you or someone else?
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Myself
Someone else
Do you own other pets at the current time?
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No
Yes
If yes, please list their names, breeds, and ages.
Are all of your pets spayed/neutered/fixed?
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Yes
No
N/A
How many pets have you owned in the last 5-10 years?
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What happened to them?
Are your pets current on their vaccinations?
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Yes
no
n/a
Have you ever turned your dog or cat into a shelter?
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No
Yes
If yes, please explain?
Veterinarian's Name
*
Veterinarian's Address, City, Province, and Postal Code
*
Veterinarian's Phone Number
*
Have you ever had a pet euthanized?
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No
Yes
If yes, please explain:
How do you feel about having pets spayed/neutered?
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Agree
Disagree
Not Sure
Are you familiar with heartworm and heartworm prevention?
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No
Yes
If you have pets, will they adjust to a new pet in the house?
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Yes
No
Unsure
N/A
Were any of your pets obedience trained?
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Yes
No
N/A
Please check the main reason you plan to adopt a pet:
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Companion
Family Pet
Child's Pet Guard Dog
Companion for another pet
Other
If you answered "other" above, please explain here:
Please describe in detail the pet you are looking for.
Do you own or rent your home?
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Own
Rent
Someone else owns the Home
Someone else rents the Home
Please select your current residence type.
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House
Apartment
Condo
Townhouse
Mobile Home
Other
If you answered "other" above, please explain here:
How long have you lived at this address?
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Less than one month
1-2 months
3-6 months
6-9 months
9-12 months
1-2 years
3-5 years
6-10 years
10 + years
If you rent, does your landlord and lease allow pets?
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Yes
No
Unsure
N/A
Landlord's Phone Number
Including yourself, how many people live in your household?
*
Please list the ages & relationship of those who live in your home.
*
Is everyone in your household aware that you are planning to adopt a pet?
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Yes
No
N/A
Does anyone in your household have allergies to dogs/cats?
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Yes
No
Possibly
N/A
Employment Status
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Full-Time
Part-Time
Retired
Work from Home
Stay at Home Parent
Student
Unemployed
Other
If you chose "other" above, please explain:
If you are employed, what is your current occupation?
On average, how many hours per day will your pet be left alone?
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How much do you think the annual medical bills will be for your pet?
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About $100
$100 - $200
$200 - $300
$300 - $500
$500 +
What would you do if the bills went over this amount?
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Will this pet be predominantly living inside, outside, or both?
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Inside
Outside
Both
Please provide a description of this pet's living conditions.
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Do you have a completely fenced-in yard? If so, what kind of fence?
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Wood
Chain Link
Electric
Plastic
Iron
Other
Other (I do not have a fenced yard)
If you answered "other" above, please explain:
If you do not have a fenced yard, how will you let the animal out?
*
Are there times when the animal will be tied/chained up?
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Yes
No
N/A
If yes, when will they be tied/chained up?
Where will the animal sleep?
*
In bed with me
In bed with my child
In a dog / cat bed
In a kennel / crate
Wherever he or she likes
Outside
Other
If you answered "other" above, please explain:
Will the animal spend any time in the garage?
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Yes
No
N/A
If the animal will spend time in the garage, please explain when/why:
How will you handle housebreaking?
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How will you handle destructive behavior?
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Will you keep the animal up-to-date on vaccinations and heartworm preventative?
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No
Yes
If no, please explain:
Are you willing and able to exercise the dog on a regular basis?
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Yes
No
N/A
If yes, what is the method of exercise?
Walking
Running
Dog Park / Dog Run
Other
If you answered "other" above, please explain:
Have you ever been convicted of abuse or neglect of a child or animal?
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No
Yes
If yes, please explain:
If you drive a pick up truck, would you allow the animal to ride in the back/bed?
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Yes
No
N/A
What arrangements will you make for the care of your pets in case of an emergency?
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Leave with family/friend
Boarding
Pet Sitter
Take with me/us
Other
If you answered "other" above, please explain:
What will you do with the animal when you go on vacation?
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Leave with family/friend
Boarding
Pet sitter
Take with me/us
Other
If you answered "other" above, please explain:
For what reason(s) would you consider returning/giving up the animal?
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What would you do with your animal if you had to move?
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Take him / her with me
Give to family or friend
Return to shelter
Other
If you answered "other" above, please explain:
Are you willing to take responsibility for this animal for the next 10-20 years?
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No
Yes
If no, please explain:
Will you allow the NL West SPCA to perform home checks?
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No
Yes
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 references, landlords, associations and veterinarians. I am also aware that the NL West SCPA cannot guarantee the health and temperament of the animal.
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Yes
No
References:
Please supply THREE references. Only one reference may be a family member.
The others should be non-relatives (I.E: coworkers, friends, etc.)
Reference 1:
Name
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Relationship
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Phone number
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Address
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Reference 2:
Name
*
Relation
*
Phone number
*
Address
*
Reference 3:
Name
*
Relation
*
Phone number
*
Address
*
Any additional notes or info you'd like us to consider?
Sign here:
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