Elmore SPCA Personal Reference Form

Elmore SPCA

Adoption Personal Reference Form
Please complete this personal reference fully. Giving only yes/no responses without any further explanatory detail could slow the reference approval process.
Date *

Month Day Year
Date
Name *

First Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Phone Number *

Area Code Phone Number
Email *
example@example.com
Name of individual you are providing personal reference for *

First Name Last Name
A personal reference cannot live in the same household as a applicant. *

By checking this box, I attest that I do not live in the same household.
Your relationship to the applicant *
How long have you known the applicant? *
How many pets does the applicant currently own? Please describe each. *
Are there other pets in the household that are not owned by applicant? If yes, please describe each. *
Are there any pets that reside at this residence that are not spay/neutered? *

No Yes I do not know
If answered yes to above question, which animals have not been spay/neutered? otherwise enter NA. *
To your knowledge, has the applicant ever given away any previously owned animal to a person, shelter, or rescue group? If yes, please describe circumstances. *
In your opinion, does the applicant have sufficient resources (time, space, financial for care and vetting, etc.) to responsibly care for an additional adopted pet? Please provide details. *
Do you personally know the applicants pet(s)? If so, how well trained/behaved are they? *
Would you let the applicant take care of your own pet(s) if you were away? *
Are there any concerns you have regarding this applicant adopting a pet from us? *
By checking the box below, I attest that... *

All the reference information I have provided herein is true and accurate, and no relevant information has been omitted.
Should be Empty: