Northampton Co. NC Animal Shelter
Adoption Application
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Todays DATE
-
Month
-
Day
Year
Date
I am interested in:
Cat
Dog
I am interested in adopting: (Animals Name/Description)
Have you owned a pet previously/pet experience?
YES
NO
Number of children at home?
Ages of Children in the home?
This dog/cat is for:
Gift
Guard Dog
Pet/Companionship
Support Animal
Other
Number of dog/cats you have NOW?
Are all your pets male and female "fixed" now?
Yes
No
Fenced Yard
No
Solid Panel Fence
Chain Link Fence
Pen
Underground Electric
Are you looking for an inside or outside pet?
Have you had to rehome a pet or turn into a shelter? Why?
Who is your Veterinarian? where located City/State
What day of week is best for the home visit?
Back
Next
ADOPTION CONTRACT
I agree to take my new pet for annual vet checkups and keep vaccines current on him/her
I agree
If I am unable to keep this pet, I will contact the shelter from which I obtained before rehoming him/her myself.
I agree
I understand owning a pet is a financial expense and burden, I have the means to properly care for this pet if emergency medical care is needed.
I agree
I will maintain my new pet on monthly flea/tick/ heartworm prevention or as recommended by my vet.
I agree
If this animal is too young to spay/neuter at time of adoption, I will do so within 60 days of adoption, at my expense or by voucher whichever is available at the time
I agree
By signing/typing my name I agree to these terms, you may call my vet for a reference and do a home visit as needed prior to adoption.
Submit
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