Second Chance Animal Center

Second Chance Animal Center

DOG ADOPTION APPLICATION
Applications are processed Monday through Friday and can take up to 5 days to complete. You will not hear from us during the processing period unless we need additional information. The final decision regarding this application will be sent to your email address as provided on this form. INCOMPLETE APPLICATIONS WILL DELAY PROCESSING TIME.
Adopter's Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Mailing Address (if different):

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail*
Background Information
Adopting a dog brings with it a lot of responsibility, including annual veterinarian visits, vaccinations, and possible emergency care. This is more expensive than many people realize. Are you aware of and prepared to assume the responsibilities for your newly adopted dog?*

YesNo
It can sometimes take a shelter animal up to 3 months to acclimate in their new home, and returning a dog to the shelter because they are shy and hesitant for a few weeks can cause a great deal of stress and lead to medical problems. Are you willing to be patient for several weeks during this acclimation period?*

YesNo
I currently own a
For how long?
I currently rent a
For how long?
Landlord's Name

First NameLast Name
Landlord's Phone Number

Area CodePhone Number
I currently live with family or friends in a
For how long?
Home Owner's Name

First NameLast Name
Home Owner's Phone Number

Area CodePhone Number
Are you a first-time dog adopter as an adult?

YesNo
If NO, how many dogs have you lived with?
List Veterinarian Reference
Name on Account at Veterinarian's Office
Have you ever adopted an animal from SCAC?

YesNo
If yes, what type of animal?
When?
Have you ever surrendered an animal to SCAC?

YesNo
If yes, what type of animal?
When?
Why?

List all pets currently in your household or pets you have owned in the last 5 years.*

	Animal's Name	Type/Breed	Spayed/Neutered?	Owned how long?	Still own?	If no, what happened?

*If you currently have a dog(s), we ask that you bring it/them in to meet the potential adoptee.
I also live with

Other petsChildrenOther adults
Describe any other pets:
How many children and ages:
Other adults, how many?
Do you or anyone in your family suffer from allergies?

YesNo

Second Chance Animal Center

Adopter's Information

Background Information

Your New Dog: Physical Traits

Your New Dog: Other Traits

Life at Your Home

Applicant Signature

Authorization to Release Information