VCAS Dog Adoption Application
Vermilion County Animal Shelter 14775 CATLIN TILTON RD. DANVILLE, IL 61834 PHONE NUMBER: 217‐431‐2660
Note: We reserve the right to refuse any adoption we consider unsatisfactory.
Full Name (First and Last)
Your answer
Date
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Date of Birth
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Full Address
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Primary Phone Number
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Alternate Phone Number
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Email Address
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Driver License Number
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Are you looking to adopt one or two dogs?
Name of the dog(s) you are interested in - in order of priority
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Your reason(s) for choosing to adopt a dog
Your answer
Thank you for considering the adoption of a shelter animal!Before you decide to adopt a pet, please consider the time, effort and funds for food, supplies, vaccinations and veterinary care necessary to properly maintain an animal. The decision to adopt a pet is an important one. In order to insure that you and your pet will be happy for years to come, we need you to take time to discuss your and the animal’s individual needs and personality traits. Please take a few minutes to read and complete this application. If there is more than one application submitted, the adopter that best meets the needs of the dog will be approved.THE FOLLOWING CONDITIONS MUST BE MET IN ORDER TO APPLY:APPLICANTS MUST BE 18 YEARS OF AGE, ALL RESIDENTS OF HOUSEHOLD MUST AGREE TO ADOPTION. CHILDREN AND ALL RESIDENTS OF THE HOUSEHOLD MUST MEET WITH THE DOG PRIOR TO THE APPROVAL.
CARING FOR A DOG CAN BE A 15+ YEARS COMMITMENT. THE FINANCIAL COMMITMENT OF OWNING A DOG IS $1000.00 + ANNUALLY. PLEASE CONSIDER THESE COMMITMENTS CAREFULLY.
ARE YOU WILLING AND ABLE TO MAKE THESE COMMITMENTS TO THIS DOG?
PERSONAL INFORMATION:
1) Do you currently live in a:
If other, please specify
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2) Do you currently:
If other, please specify
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3) How long have you lived there?
Your answer
4) Are you planning to move in the next 6 months?
5) Previous address
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6) Length of time at previous address:
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7) If you move, what will you do with the dog?
8) If you rent, please provide Landlord’s Name:
Your answer
Landlord Phone
Your answer
9) Employer/Business
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How long at current job?
Your answer
10) How many adults live in the home?
Your answer
What are their names and ages?
Your answer
11) How many children live in the home?
Your answer
What are their names and ages?
Your answer
12)Does anyone in your household have allergies?
13) Who will be primarily responsible for the care of this dog?
Your answer
14) Name of reference not related or living with you:
Your answer
15) Phone number of reference:
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16) Which of the following best describes your reasons for wanting to adopt this dog? (Check all that apply)
If other, please specify
Your answer
17) How will you keep the dog confined on the property? (Check all that apply)
If other, please specify
Your answer
18) If you plan to leave the dog outside, please describe in detail the outdoor shelter you will provide
Your answer
19) How many hours will the dog be alone each day?
Your answer
20) Where will the dog be kept when no one is home?
Your answer
21) Where will the dog be kept at night?
Your answer
22) Do you have a fenced yard?
Type of fence?
How high is the fence (in feet and/or inches)
Your answer
23) How long do you plan to keep this dog?
Your answer
24) What arrangements would you make if you no longer can keep this dog?
Your answer
25) LONG TERM COMMITMENT. Which of the following would cause you to give up this dog?
If other, please specify
Your answer
26) If you have other pets, are their vaccinations current?
27) Are they currently licensed with your county?
28) Are your pets on flea/tick preventative?
29) Are your pets on heartworm preventative?
30) In the section below please list the NAMES, SPECIES, AGE, BREED, and SEX of all of you current pets
Your answer
Please specify if all of your pets spayed or neutered
Your answer
Please indicate whether your current pets are kept iside/outside
Your answer
31) Name of your veterinarian
Your answer
32) Phone Number of your veterinarian
Your answer
33) In the following list all the pets you have had in the last 10 years:
Your answer
Indicate the (1) Breed of each, (2) how long did you have each, and (3) what happened to each of them:
Your answer
34) Have you ever adopted a pet from a shelter?
If yes, where and when?
Your answer
35) Have you ever relinquished a pet to a shelter before?
If yes, when and why?
Your answer
36) Have you ever given a pet away?
If yes, when and why?
Your answer
37) Have you or any member of your household ever owned an animal that has been confiscated by any animal control for violations of state or local animal control regulations or an animal adoption agreement?
If yes, when and why?
Your answer
38) Have you or any member of your household ever been subjected to legal action for cruelty or neglect of animals?
If yes, when and why
Your answer
39) Do you agree to provide basic medical vet care for this dog?
If not, why?
40) You agree to provide rabies vaccinations according to Vermilion County Ordinance?
If not, why?
41) You agree to maintain heartworm and flea/tick prevention all year long?
If not, why?
42) Do you have any objections to an inspection of your premises by VCDAR?
43) Do you understand the local ordinances concerning: Licensing, Rabies Vaccinations and leashing?
I hereby release to the Vermilion County Animal Shelter all veterinary records of any and all animals I own and have owned. I certify that the above information is true and correct to the best of my knowledge. I also acknowledge falsification of the above can result in my being denied adoption of an animal or, if an animal has been adopted to me, the return of the animal to the Vermilion County Animal Shelter.
Name (First and Last)
Your answer
Date
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