Pet Adoption Application: Second Chances Pet Rehab & Sanctuary

S.C.P.R.S. is an all-volunteer, non-profit, animal welfare organization dedicated to the rescue and placement of stray, neglected and abused animals. S.C.P.R.S. is completely funded through fundraising efforts and public donations. All of our pets are cared for by foster homes and receive complete medical care, which includes deworming, vaccinations, spaying/neutering and microchipping prior to their adoption.

This questionnaire is designed to help S.C.P.R.S. and yourself determine if a specific animal is the right one for you and your household. All adopting parties are required to complete this form prior to adoption. S.C.P.R.S. reserves the right to deny any adoption based on answers to this questionnaire and/or interviews prior to adoptions!

Name of the animal you are interested in adopting (put "open" if you do not have one you are specifically interested in and we can match you with the perfect pet for you and your household):*

Your full name:*

Date of birth:*

Drivers License number:*

Street Address:*

City*

State*

Zip*

Primary Phone:*

Area CodePhone Number

Secondary Phone:

Area CodePhone Number

E-mail:*

Are all members of your household in agreement with this adoption?*

YesNoDon't Know

Who will be the pet's primary caregiver?*

Do you live in a*

HouseApartmentCondoOther

Do you own or rent?*

OwnRent

If rent, provide name and phone number of landlord: (Applications that are submitted without landlord/office info. will not be looked at)

Does your landlord allow animals?

YesNo

Are there any restrictions from your landlord or subdivision?*

Number of petsSize or weight restrictionsBreed restrictionsNone

Do you have a fully fenced yard?*

YesNo

Height and type of fence

Do you have any of the following?

Underground fenceKennelDog Run

How many adults are in your household?*

How many children are in your household?*

If children, what are their ages?

Have your children been around animals before?

YesNo

Does anyone in your home have allergies to animals or have asthma?*

YesNo

List any pets you own: Names, breeds, ages and if they are altered or not:*

Please provide the name and phone number of your current and/or previous veterinarian or clinic:*

What type of personality do you want your pet to have? (i.e. calm, energetic, protective, couch-potato)*

Are you aware of crate training?*

YesNo

We cannot guarantee the animal is house broken or trained; are you willing to train with love and patience?*

YesNo

How many hours each day will your new pet be home alone?*

Where will your new pet sleep at night?*

Where will your new pet stay when nobody is home?*

How will you exercise your pet (if applicable)? Please list parks near by, how many walks per day, approx. length of walks, and any other activities you plan to do with your pet.*

What length of time will you allow your new pet to adjust to their new home?*

Are you willing to work through your new pet's issues, if any?*

YesNo

Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior?*

YesNo

Do you understand that a pet can be an 18 year commitment, and can cost $300 - $500+ per year to care for?*

YesNo

Are you willing to take an obedience class with your dog if needed?*

YesNoNot sureNot Applicable

If yes, where?

Are you aware that a large breed dog takes about two years to mature? Is this something you're prepared for?*

YesNoNot Applicable

What circumstances would lead you to give up your new pet?*

Do you agree to let S.C.P.R.S. know if the adoption does not work out at any point so that we can make arrangements to take the animal back? Do you agree to give us at least 2 weeks to place the animal in a new home or foster if this occurs?*

YesNo

Do you understand that your adoption fee is nonrefundable for any circumstances after it has been paid?*

YesNo

Do you agree to a home check before and after adoption?*

YesNo

Do you understand that your new pet should be kept from the current pets in your home for a period of time to allow the new pet to acclimate and adjust to their new home?*

YesNo

Do you understand that although the animal may seem healthy that it could have symptoms that have not yet presented themselves and that is also why the quarantine period is necessary? S.C.P.R.S. is NOT responsible for any vet bills that may incur for pets already in the home or foster(s) from another rescue in result of the pets coming in contact with a pet from S.C.P.R.S.?*

YesNo

Do you understand that if the animal is not yet altered that it MUST be altered BEFORE the adoption can be finalized (a service that S.C.P.R.S provides) or S.C.P.R.S reserves the right to remove the animal from your possession?*

YesNo

Do you understand that flea/tick preventative and/or Heartworm preventative is solely the foster to adopt/adopters responsibility to provide and is a necessary expense to keep your pet healthy?*

YesNo

Cat adopters: Do you understand that cats/kittens are NOT combo tested (FIV/FELV) unless otherwise stated? Do you understand that S.C.P.R.S. does not provide the feline leukemia vaccine- (we only provide mandated core vaccines and rabies)?*

YesNo

How did you find out about S.C.P.R.S.?*

By sending this electronically, I acknowledge that I have completely read this questionnaire and comprehend it fully. I understand that applying does not ensure approval and that untruthful answers or failure to comply with the requirements of this application can result in the forfeiture of any S.C.P.R.S. animal adopted by me. I fully understand that the adopted animal can be removed by S.C.P.R.S. at anytime from my care if I do not comply with all of the terms presented to me. I certify that the above information is correct, and I understand that the information will be verified. I understand that by submitting this form electronically, I agree to release and covenant to hold S.C.P.R.S. and it's members from any claims, damages, costs, harmless or actions incurred because of the care or actions of the adopted animal. I accept full responsibility for the adopted pet(s) actions at all times, and release S.C.P.R.S. from any liabilities or damages that may be incurred. I agree that if I am unable to keep or care for my pet anymore that I will return the animal(s) to S.C.P.R.S. and try to give S.C.P.R.S. a 2 week period to try and find another suitable home or foster for the animal(s). I understand that I assume full responsibility for the welfare of this pet from the date of adoption. I understand that S.C.P.R.S. is not responsible for any incurred vet costs once the pet is in my home and/or possesion.

Your full name (Acts as your signature):*

Date:*

Pet Adoption Application

Applicant Information

Household Information

Current Pet Information

New Pet Information