Adoption Application

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Thank you for considering a shelter pet! To better serve you, please answer the following questions:

Email *

Adoption Application

Name of animal you are interested in: *

We cannot guarantee that the animal will be held for you.

I am interested in: *

(Select all that apply.)

Adopting

Fostering

Required

Your Name: *

(First and last.)

Phone Number: *

A number where you are most easily reached.

Home Address: Street, City & State *

(If you have lived at your current address less than a year, please list the second most recent address as well.)

If you rent, please list your landlord's phone number:

Do you currently own any pets? *

Yes

If you own pets, are they spayed or neutered? *

Yes

Not applicable

If you own pets, do they have current rabies vaccinations? *

Yes

Don't have pets

If you own pets, please tell us who your veterinarian is? *

If you own pets, please list their names, species and ages. *

Randolph County has a leash law in effect as do many other areas. How do you plan to contain your new pet? *

(Choose all that apply.)

Fence

Tie-out

Dog lot

Crate in the house

Leash walking

Loose in the house

Other:

Required

Have you ever been issued a warning or citation for an animal control ordinance violation or had an animal legally removed from your care? *

Yes

Please list all members of your household, their ages and gender: *

I certify that the above information is correct to the best of my knowledge. I understand that failure to answer honestly may result in denial of adoption. *

(Sign and date.)

A copy of your responses will be emailed to the address you provided.

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