Adoption Application Form

Name of animal (or description)
Eg. Max (Brown and white fluffy pup)
Details of Animal

CatDogOtherMaleFemale
Where did you see the animal?
Your name*

First NameLast Name
Your address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*

Area CodePhone Number
Occupation
Employer
Work Address
Work Phone Number

Area CodePhone Number
Work Hours

9am - 5pmEveningsShifts (Early / Late Hours)Part TimeOther
If part time, please give details of working hours
Transport (in case of emergency, how will you get the adopted pet to the vet?)

Own vehiclePublic tranportOther
ALTERNATIVE CONTACT PERSON:

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
PARTNER / SPOUSE / FAMILY MEMBER (person residing in same residence who will, or agrees to take responsibility for the animal in your absence)

First NameLast Name
Phone Number

Area CodePhone Number
Email
example@example.com
Occupation
Working Hours?

9am - 5pmEveningsShiftsPart TimeOther
Children: This information is required solely in order to determine whether the animal you are interested in adopting, is suitable for the ages of your children.
Do you have children:

YesNo
How many children:
Ages of children

InfantToddlerPre-teenTeenager
Do you have other pets?

YesNo
Other pets:

Cat(s)Dog(s)Bird(s)Other
Please give details of the breeds of your other pets:

Details of other pets:

	Female	Male	Sterilised	Age: Young	Age: Adult	Age: Elderly
Cat 1
Cat 2
Dog 1
Dog 2
Other

RESIDENCE:

OwnerTenantSmall HoldingHouse (freestanding)House (in estate)Townhouse / DuplexFlat / ApartmentIf tenant / in estate: are pets allowed in terms of lease / estate rules?

Property details:

	Yes	No
Is the property close to / right on a busy road?
Are there any rules about keeping a pet ?
Do any of your neighbours have pets?
Is your property enclosed with fencing / wall?
Is there a swimming pool?

Details of fencing:

High (above 6ft)Low (below 2ft)WireConcrete / brickOtherOther
The adoption animal - kitten/puppy or older cat or dog - may come to you only having received its first vaccine (if it’s old enough) and will have been de-wormed and de-flea’d – unless otherwise specified i.e. sterilized if old enough. Until the puppy/kitten has had its 2nd vaccine, it is not entirely immune to parvo virus, distemper or feline leukemia – all potentially fatal diseases. It is therefore inadvisable to expose it to areas where other dogs or cats have visited.

Please ensure your adopted animal receives its 2nd and 3rd vaccinations on time and we recommend you ensure the kitten is vaccinated for Feline Leukemia.
Do you have experience with (raising, training & living with) a young puppy / kitten into adulthood or an older rescued cat or dog:

YesNo
Are you able to feed your new puppy / kitten at least 3 times per day and throughout the night in the early stages:

YesNo
Can you ensure there is anyone home during the day to: play with, train, supervise and provide companionship if you adopt a young puppy / kitten:

YesNo
Would you say that you fully understand the responsibility, time needed and challenge you are taking on in agreeing to take responsibility for raising and training a young animal or older cat or dog?

YesNo
Would you consider taking your new puppy/kitten/older cat or dog to socialization classes or even further training?

YesNo
Why do you want to adopt a dog / cat?
Do you feel you have enough space to keep an active small or large breed dog?

YesNo
Will the dog be kept:

Indoors onlyOutdoors onlyAccess to all of property
If "Outdoors", is there adequate shelter and will the dog have any indoor access?

YesNo
Can you afford to feed a growing puppy / grown dog a healthy, balance diet? (Preferably a scientifically formulated veterinary diet, and resist the temptation to over-feed).

YesNo
How often will you feed your adult dog?
Dogs need a lot of exercise and stimulation. Are you willing and able to take your dog out for regular walks / out to different places?

YesNo
How will you train and/or discipline your dog?
Do you feel you have the right environment to keep a cat?

YesNo
Will the cat be kept:

Indoors onlyOutdoors onlyAccess to all of property
If your cat is allowed to roam, have you looked at other cats in the area? These cats may carry illnesses that may be transmitted to your cat. Will you be able /willing to vaccinate your cat against these other diseases (not included in the standard vaccinations)?

YesNo
Can you afford to feed a growing kitten / grown cat a healthy, balance diet? (Preferably a scientifically formulated veterinary diet / and resist the temptation to over-feed)

YesNo
How often will you feed your kitten / adult cat?
Cats also need attention, companionship, exercise & stimulation. Do you have time to play with and provide your cat with these important essentials?

YesNo
How will you train and/or discipline your cat?(NEVER “punish” your cat!)
General
What will you do with your animals when you go away? (eg: holiday / business)
Have you ever applied to adopt a pet from another organisation and been declined?

YesNo
If your application to another organisation has been declined, please explain the reasons given:
Have you ever surrendered a pet to an animal welfare organisation?

YesNo
If you have surrendered an animal, please explain the reasons:
Have you ever had to euthanize a pet?

YesNo
If you have had to euthanize a pet, please explain why and when:
Do you agree to and/or can your afford to:

Provide the adopted animal with necessary private veterinary care in case of illness/injury?Provide emergency care and transport in case of an accident?Provide the adopted animal with a good quality food (eg. Science Diet / Vet's Choice) appropriate for its age and size?Provide the adopted animal with clear identification (such as a collar, tag, micro-chip)?
VETERINARY CARE

Contact details of vet. (Your current vet of, if you are a "new" animal owner, which Private veterinarian's services do you intend to make use of)
Vet Practice name:
Vet Practice Address:
Vet Practice Phone number:
RULES AND REGULATIONS

The animal remains the property of SOLO (Save One Love One) throughout the duration of its life.

No animal may be transferred to another location or person without the express written permission of SOLO

Under the Animals Protection Act No 71 of 1962 you, as the Foster Parent, are responsible for the well being of the animal whilst the animal is in your care (any person having the possession, charge, custody or control of that animal).

You will be expected to return the adopted animal to SOLO if for any reason: a) you no longer want it, or b) you are no longer able to care for it to the best of your ability, or c) your circumstances change from this foster application;

You will be expected to comply with Animal Welfare philosophy and ensure your adopted animal is sterilised at six months if not before. Not adopted animals will or shall be bred with.

The adoption application is approved subject to a home check by a representative of SOLO and it is solely at their discretion to refuse the application.

SOLO reserves the right to carry out further home checks at a reasonable time and confiscate the adopted animal from you should the care, welfare and accommodation of the animal not be adequate.

Please Immediately inform us:

1. of any changes in your circumstances i.e. retrenchment or any other events likely to affect the adopted animal’s care and welfare; and/or
2. if the adopted animal falls sick from a contagious disease e.g. parvo, distemper, snuffles etc.
DECLARATION: By submitting this application, I declare that all of the questions above were answered truthfully and fully to the best of my knowledge and that by submitting this form I understand and adhere to all the rules and regulations as laid out in this document.*

Agree
Should be Empty:

General

VETERINARY CARE