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Second Chance Adoption Application
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* Indicates required question
First & Last Name
*
Example: Scott Faust
Your answer
Full Address
*
Example: 123 First St. Mansfield, PA 16933
Your answer
Best Contact Number
*
Example: 570-123-4567
Your answer
Secondary Contact Number
Example: 570-123-4567
Your answer
Email Address
Your answer
Name of pet or describe the type of pet you are interested in:
*
Example: I'm interested in a short haired cat that is young. -OR- I'm interested in adopting Scruffy.
Your answer
Why do you want to adopt a pet?
*
Your answer
What do you think are the most important responsibilities in having a pet?
*
Your answer
All pets currently with you: Name, Age, Type, Spayed/Neutered?
Example: Bailey, 10, Beagle, Neutered (then hit ENTER) add more, HIT ENTER after each pet
Your answer
Pets previously with you: Name, Type, Spay/Neuter, Reason for no longer having?
Example: Fido, Dog, Spayed, Passed Away (then hit ENTER) add more, HIT ENTER after each pet
Your answer
Veterinarian Name
Your answer
Veterinarian Phone Number
Your answer
If other than your name, what name would your pet files be under?
Your answer
People living in or visiting the house frequently: Name, Relationship, Age
*
Example: Logan, Son, 14 (ENTER) Jamie, Wife, 40 (ENTER) Will, Neighbor/pet sitter, 38
Your answer
Does anyone in your household have pet allergies?
Yes
No
Clear selection
Do you own or rent your house?
Own
Rent
Clear selection
If you rent, please provide the name and number of your landlord
Example: John Doe, 570-123-4567
Your answer
Do you have a fenced yard?
Yes
No
Clear selection
Where will the pet be kept during the day?
*
Your answer
Where will the pet be kept during the night?
*
Your answer
How many hours per day will your new pet be alone?
*
Your answer
When gone more than 8 hours, what plan will you have for your pet’s care?
*
Your answer
Having a pet involves many financial expenses such as food, flea and tick medicines, vaccinations, veterinary visits, and emergency costs. Are you able and prepared to meet these needs for the health and wellbeing of your new family member?
*
Yes
No
Reference #1 (may be related to you) Name, Relationship, Phone
*
Example: George Lucas, Father, 570-564-3452
Your answer
Reference #2 (not related to you) Name, Relationship, Phone
*
Example: George Lucas, Father, 570-564-3452
Your answer
Reference #3 (not related to you) Name, Relationship, Phone
*
Example: George Lucas, Father, 570-564-3452
Your answer
By submitting this form, I represent that the information that I have provided is truthful to the best of my knowledge and belief.
*
I agree
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