St. Clair County Animal Adoption Center Application

St. Clair County Animal Adoption Center

1250 South 11th Street Belleville, IL 62226 618-235-0585 Ext 2
ADOPTION APPLICATION
Thank you for your interest in adopting from The St. Clair County Animal Adoption Center. Completing this application does not guarantee an adoption

**Applications that are incomplete or illegible will not be processed**
NAME OF ANIMAL APPLYING FOR
Name
Address

Address

Street Address Line 2

CityState/Zip

Postal / Zip Code
Email
example@example.com
Cell #
Work #
Driver's License (State)
Driver's License #
Occupation
Alternate Contact Name/Phone #
Format: (000) 000-0000.
I currently live in a(n):

ApartmentHouseDuplexMobile HomeOther
Do you:

OwnRent
May we contact your landlord?

YesNo
Landlord's Name
Landlord's Phone #
Format: (000) 000-0000.
How long have you resided at this address?
Previous Address
Do you own a yard?

YesNo
If yes, what is the size of the yard?
Do you have a fence?

YesNo
If yes, how tall and what type of fence?
How many adults live in your household?
Are there any children in your household?

YesNo
If yes, what are the ages?
Is this your first experience with a pet?
Please list your reasons for wanting to adopt a pet
How did you hear about the St. Clair County Animal Adoption Center?
Family Pets
Do you have pets of your own, that live with you currently:

YesNo
Types of Pets:

DogsCatsOther
Are your pets current on all their vaccinations and altered?

YesNo
If no, explain
Veterinarian's Name and Phone #
Format: (000) 000-0000.
Please list ALL pets currently living in your household (Name, Breed, Age, Sex, Spayed/Neutered)
Where do your pets primarily live?

IndoorIndoor/OutdoorOutdoor
If outdoor, please explain;
Are all pets on flea prevention?

YesNoI don't own other pets
Are all dogs on heartworm prevention?

YesNoI don't own dogs
Have your dogs been tested for heartworms?

YesNoI don't own dogs
Results/Dates
Have your cats ever been tested for FIV/FELV?

YesNoI don't own cats
Would you ever declaw a cat you adopt?

YesNoI am interested in a dog
Have you ever given up a pet for any reason?

YesNoIve never owned pets
If yes, why did you give up the pet and where did the pet go?
How many hours a day will the pet be alone?

0-3 hours4-7 hours8+ hours
How will your new pet be housed when alone?

LooseCratedSeperated
Where will your pet be during the day?
Where will your pet be at night?
Under what circumstances would you need to return a pet?

Barking/NoiseChewingDiggingAggressionEscaping from yard/homeTravel/MovingJumpingShynessPersonal IllnessFearful BehaviorSheddingSeperation AnxietyNot housetrainedOther
To help resolve problems with your pet are you willing to:

Use a crateWork with a behavioralist or trainerTalk or work with one of our staff memebersTalk or work with your local veterinarian
Thank you again for your interest in adopting from the St. Clair County Animal Adoption Center. We will process your application, and we will contact you to let you know the application status. All adoptions are completed as first come, first serve, meaning if a dog has multiple approved applications, whoever can take custody of the animal first will get first preference. Please be advised that filling out this application is NOT a guarantee of being selected. Signing below, I certify that the information I have given is true and that I recognize that any misrepresentation of fact may result in me losing the privilege of adopting a pet and nullification of any contract in the future. I understand that the St. Clair County Animal Adoption Center has the right to deny my request to adopt an animal, and I authorize the investigation of all statements on this application.
Print Name
Date

MonthDayYear
Date
Signature
**CONTRACT is TO BE SIGNED WHEN THE ADOPTION is COMPLETED**
Should be Empty:

St. Clair County Animal Adoption Center

ADOPTION APPLICATION

Family Pets