Adoption Application

Adoption Application
NYS Registration No: RR0110

All personal information collected on this application will be kept strictly confidential.

Only completed applications will be processed by the SPCA Adoption Counselors - please make sure that all of the necessary fields are complete and accurate. Submission of this adoption application does not guarantee an adoption nor does it immediately qualify one for an adoption. Only approved applications can secure a courtesy hold on a specific animal. We may take multiple applications to ensure the best fit for the animal. Applications are not selected on a first-come, first-serve basis.

For more information or questions on a specific animal or on the adoption process, please call our adoption counselors at (607) 732-1827, Ext. 2201.

Are you interested in a cat or dog?*

CatDog
Animal Name/ID Number*
If you don't have a specific animal in mind that is available for adoption, please describe what kind of animal you are looking for (eg breed, size, age, personality, etc - for example - chihuahua, or small older dog, or long-haired kitten)

Personal Information
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Please list all family members in household (with ages):*

Residential Information
Do you own or rent?*

OwnRent
Does your landlord allow pets?*

YesNoDon't knowDoes not apply to me
Landlord's Name*

First NameLast Name
Landlord's Phone Number*

Area CodePhone Number

Pet History
Please list all pets currently living in your home including type and age:*
Are all of your current pets spayed or neutered?*

YesNoI have no other pets
Are all of your current pets vaccinated?*

YesNoI have no other pets
Name of current/past veterinarian:
To bring your animals current on their core vaccinations please visit your current veterinarian or CLICK THE LINK BELOW to schedule an appointment at our next available Affordable Vaccine Clinic held weekly at the SPCA.

https://clinichq.com/online/e6f366b5-8d07-41c6-9a22-7dd17baac6fb
If you have other pet(s), please upload their vaccination records:

Browse Files

Cancelof

By signing this document, I am accepting all of the risks associated with the handling of animals during the adoption process. I understand that this document will be retained on file by the Chemung County SPCA.

By submitting this adoption application, I hereby attest that all information supplied is true and accurate. I further state that I understand supplying false information on this application constitutes fraudulent misrepresentation. If such fraudulent misrepresentation becomes apparent or is otherwise discovered by the Chemung County SPCA, I understand the following:
- The ensuing adoption is null and void
- The Chemung County SPCA will seek the return of the adopted animal by all means available to it under New York State law
- The Chemung County SPCA will pursue all additional remedies available to it under New York State's Uniform Commercial Code 2-721
- If any legal fees are incurred by the Chemung County SPCA as a result of enforcing its rights and pursuing the return of the adopted animal, the Chemung County SPCA will seek reimbursement for any such fees
Please type your full name*
Signature

Clear
Date*

MonthDayYear
Date
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