Dog Adoption Application

Full Name: *
Street Address: *
City: *
State: *
Zip Code: *
County: *
Home Phone: *
Cell Phone:
Work Phone:
Email Address: *
Personal Reference One Name: *
Personal Reference One Phone Number: *
Personal Reference Two Name: *
Personal Reference Two Phone Number: *
Personal Reference Three Name: *
Personal Reference Three Phone Number: *
Personal Reference Four Name: *
Personal Reference Four Phone Number: *
Animal you wish to adopt: *
What is your primary reason for adopting this animal?: *
Housing Situation	Rent Own Live with someone else
Type of housing	Condo House Apartment Mobile home
If you rent, what is the landlord or rental property name?:
Landlord/rental agent contact number if renting?:
If renting how many animals are you allowed?:
Is there a weight limit?:
If yes, what is it?:
Is anyone in your household allergic to animals?: *
If yes, who?:
Who is this adoption for (Ex yourself, family, friend)?: *
If you move in the future what will you do with this pet?: *
How many adults are in the household?: *
How many children are in the household?: *
What are the childrens ages?:
How many animals are in the household?: *
Please list type, breed and age of other animals in the house.:
Are all the animals in the house spayed or neutered?:
If no, please explain why?:
Will this pet be kept: *
Is your yard fenced?: *
Is it completely fenced?:
What type of fencing is it?:
If it is not fenced, what arrangements do you have for the pet's toilet duties and exercise?:
Will you use a crate to confine the pet?: *
If yes, when and why?:
Who will be the primary caregiver for this pet?: *
What is the average time the pet will be left alone?: *
Will anyone be home during the day?: *
Will anyone be home during the evening?: *
Have you ever owned a cat or dog before?: *
If yes, what type?:
Have you ever adopted an animal from a shelter or rescue before?: *
If yes, what type?:
Do you still have the animal?:
If no, please explain why.:
Have you ever taken an animal to Animal Control/Humane Society or shelter before?: *
If yes, please explain where and why.:
Have you had an animal die under your care recently?: *
If yes, please explain.:
Current veterinary clinic: *
Current veterinary clinic address:
Current veterinary clinic phone number:
If you do not currently have a vet, which one do you plan to use?:
	By checking this box I agree that I have filled out this form truthfully and that SCR may have questions/perform a home visit prior to approval of my application.