Adoption Application - Chemung County SPCA

What happened to these pets?_____________________________________________________________________________________________________________________________________________________________Have you ever given up a pet? Yes No Explain:_________________________________________List all current pets in your household. Include: type, gender, age, spayed/neutered.________________________________________________________________________________________________________________________________________________________________________________________Current/Past Veterinarian:____________________________________________________________________Address/Phone:_____________________________________________________________________________Additional InformationWhat influenced your decision to adopt from our shelter? (Check all that apply) Adopted here before Radio Newspaper Website Word of Mouth Pet of Week Ad Newsletter Offsite/adoption event TelevisionReason for wanting this pet: (Check all that apply) Family Companion To Breed Mouser Guard Dog Gift Hunting Companion for other animal For Children Other:___________________________________________________________________________Who will be the principal caretaker?___________________________________________________________How much do you plan to spend yearly on this pet? $50-$99 $100-$499 >$500Will you provide regular veterinary care to your pet? Yes NoFood and veterinary care can be costly, can you financially support a pet? Yes NoHow will you help your new pet adjust to a new home environment?__________________________________________________________________________________________________________________________How long will you allow your new pet to adjust?_________________________________________________For what reasons might you need to return your pet to the SPCA:________________________________________________________________________________________________________________________________________________________________________________________Additional Comments:____________________________________________________________________________________________________________________________________________________________________For Dog Adoptions Only…Will you license your dog? Yes No Are you aware of dog control laws? Yes NoHow much exercise will you provide for your dog?______________________________________________What type of exercise will you provide?____________________________________________________________________________________________________________________________________________________How will you train your new dog?______________________________________________________________Do you plan on taking your new dog to obedience class? Yes NoBy signing this document, I am accepting all of the risks associated with handling animals during theadoption process. I understand that this document will be retained by the SPCA. I further attest that theinformation given is true and understand that giving false or incomplete information may result in theapplication being denied._______________________________________Signature__________________________________Date…Continued on next page…