Adoption Aplication

Tuesday, 21 May 2013

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Adoption Application

Thank you for your interest in adopting one of our animals. We believe that adopting a dog or cat is a privilege, involving a serious commitment. This application is therefore designed to assist us in placing animals in appropriate homes, as well as matching the ideal pet with each prospective caregiver.

Please fill out this form to the best of your ability and a representative will contact you to schedule an appointment.

Dog or Cat? Dog Cat *

Name of pet you are applying for *

Date: *

Name *

Address *

City *

State *

Zip Code

Email *

Phone

Cell Phone

Type of Residence House Apartment Own Rent *

How long have you lived at this address? *

Plans to move? Yes No *

How did you hear about Staten Island Animal Rescue?

Family and Household Information

Number of adults in the household: *

Have all of the adults agreed to this adoption? Yes No *

Do you have roommates? Yes No *

Number of children in the household: *

Ages:

Anyone allergic to animals? Yes No *

Why would you like to adopt an animal from us? Companion for self Companion for child Mouser Gift Companion for another pet Companion for another household member *

Household activity level: *

Employment Information

Employmment Status *

Your Pet History

Do you currently have any dogs or cats? Yes No *

Have you ever given an animal away or relinquished an animal to a shelter? Yes No *

Name of veterinarian or clinic *

Phone *

May we contact your veterinarian for a reference? Yes No *

Where will your new pet be kept during the day? *

During the night? *

Do you have a doggie door? Yes No *

Do you have a fenced yard? Yes No *

How many hours a day will your new pet be left alone on weekdays? *

How many hours a day will your new pet be left alone on weekends? *

What will you do if your cat develops a problem with: scratching, meowing, chewing, separation anxiety, marking, etc?

Do you or anyone in your home smoke? Yes No *

Please check if you agree that you understand this application process.

By checking "I agree", you certify that the information you have provided is true. You understand that Staten Island Hope Animal Rescue reserves the right to deny your application for any reason. You further authorize the investigation of all statements in this application.

Please Check I agree I do not agree *

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