Saving Sampson Adoption Form

Which pet are you looking to adopt?*

Your Name*

First NameLast Name

Your Address*

Street Address

Street Address Line 2

CityState

Zip Code

Your Email*

Your Phone Number*

Phone Type*

CellHomeWork

Names and ages of all permanent residents of your home (adults/children):*

Please list any pets currently living in your home, and if they are vaccinated and spayed/ neutered:*

Who is your veterinarian? (If you have not been to a vet before, please put why)*

Vet name, address, & phone number

In your care, will this pet stay indoors, outdoors, or a combination of both?*

When will you be ready to adopt this animal?*

TodayWithin a weekWithin a monthNot ready yet, just researching!

Is anyone in your home allergic to the animal you're planning to adopt?*

YesNoYes, but it is tolerable for them and they are OK with it.

Do you rent or own the property you reside at?*

RentOwn

If you are a renter, you must provide us a written letter from your landlord or a copy of the section of your lease stating that you are allowed to have this type of animal and showing any limitations.

Have you discussed this adoption with all members of your household?*

YesNoYes, adults have discussed. Kids don't know yet.

Please be aware that dogs/cats given as gifts for the holiday season are often returned to the shelters. With this in mind, please make sure that you're aware that that a pet is a lifetime (15 - 20 year) commitment.

FOR DOGS ONLY: Do you have a yard?*

Yes, I have a fenced in yardYes, I have a yard without a fenceNo, I don't have a yard (apartment, condo, etc.)N/A - Filling out application for a cat.

FOR CATS ONLY: Do you plan to declaw this cat?*

YesNoN/A - Filling out application for a dog.

Why are you looking to adopt today?*

Do you have any additional comments, questions or concerns?

By checking the box below, you understand the terms of this form and agree to our adoption requirements. You agree that you will love and care for this animal for the rest of its life, and you are ready to commit to that. You also agree, that if for any circumstances you can no longer provide a good home for this animal, you will return them to Saving Sampson.*

I understand the above, and have tried to the best of my knowledge to make sure all information is correct.

By checking the box below, you understand that our adoption fee is non-refundable after the adoption is finalized.*

I understand the above statement.

By checking the box below, you understand that Saving Sampson makes no guarantees regarding this animal's health or temperament, and is not liable for any future damages or injuries that may be caused by this pet.*

I understand the above statement.

Adopter's Signature:*

Date:

Thank you for taking the time to complete our adoption application. Please feel free to contact us with any questions at savingsampsonpets@gmail.com.

After you click submit, you will be redirected to the main page, and you will also recieve a confirmation email. Thank you again, and we will contact you soon!

Type a question

S.S. Online Adoption Application