North Quabbin Regional Animal Control Adoption Application

North Quabbin Regional Animal Control Adoption Application

Please fill out this form to apply for adopting a pet from our shelter. Your answers help us find the best match for you and ensure a safe and loving home for our animals.
Name of animal applying for:*
Full Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Home Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Age of Person Adopting*
How many adults live in your household and what are their ages?*
Do you have children living in your household?*

YesNo
How many children live in your household and what are their ages?*
Who is your employer? Please include street address and phone number*
Please describe your living situation (house, apartment, fenced yard, etc.)*
Do you rent or own?*

RentOwn
For renters: Please list your name and phone number of your landlord.
How long have you lived at your current residence?*
Do you plan to move within the next 12 months?*
Have you ever adopted from North Quabbin Regional Animal Control before? *
If yes, do you still have this pet? If you do not still have this pet, why not?
Have you ever adopted from another shelter? If yes, what shelter?*
If you have adopted from another shelter, do you still have this pet? If no, why not?
Have you ever surrendered an animal to a shelter or animal control? If yes, what were the circumstances?*
If anyone in the home allergic to cats? Dogs? *
Are you going to keep the animal indoors, outdoors, or both?*

IndoorsOutdoorsBoth
Do you currently have any pets?*

YesNo
If yes, please list your current pets (species, age, etc)
Are your pets current on their vaccinations?*

YesNo
Are your pets spayed or neutered?*

YesNoSome are, some are not.
Have any of the cats in your household been diagnosed with the following:*

Feline Leukimia (FeLV)Feline Infectious Peritonitis (FIP)Feline Immunodeficiency Virus (FIV)None
Have any dogs in your home been diagnosed with the following?*

HeartwormCanine DistemperParvovirusNone
Please provide the name, address, and phone number to the vet you use.*
Do you ever use any other vet clinic/hospital or emergency vet?*

YesNo
If yes, who?
Please list all pets owned within the past 5 years including those that are deceased, lost, stolen, sold, or given away. Please list their name, breed, age, length of ownership and if they were spayed/neutered.*
By signing below, I confirm that all information in this application is correct and complete and that I authorize my landlord and veterinarian to release information confirming this application to the North Quabbin Regional Animal Control facility for verification. Failure to provide accurate information will forfeit my adoption fee and revert ownership of this animal to the North Quabbin Regional Animal Control Facility. I understand that the North Quabbin Regional Animal Control facility has to the right to refuse placement of an animal for any reason. Animals may be removed from unsuitable homes at any time based upon the discretion of the North Quabbin Regional Animal Control Facility.*

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