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SMAS Canine/Feline Adoption Application
Prior to the adoption of an animal, we ask that you complete this application. This information will help us achieve our goal of finding permanent, responsible, loving homes for the animals in our care and allow us to better assist you in finding a pet suited to your needs
Name of pet your are interested in adopting
Name
*
First
MI
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
Phone
*
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-
###
-
####
Email (must provide email address to receive gift of pet insurance)
Are you 18 years old or older
Yes
No
Which best describes your housing situation?
*
House
Condo/Town house/ Duplex
Apartment
Mobile Home
Farm
Dorm
Other
Do you own or rent the above mentioned place?
*
Own
Rent
Buying on contract
Live with Parents
Other
Landlords Name
First
Last
Landlord's Phone Number
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-
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Are you adopting for an ESA?
Yes
No
If Yes, do you have your paperwork done?
Yes
No
Have you ever adopted a pet from an animal shelter?
*
Yes
No
If Yes, what kind of pet did you adopt?
Where is this pet now?
Have you ever surrendered an animal to an animal shelter?
*
Yes
No
If yes, why did you have to surrender the animal? Date of Surrender?
Are there children living in the household?
*
Yes
Yes, part time
No
Please list ages of children in the household
*
If no children are in the household, type N/A
Does anyone in the household have animal allergies?
*
Yes
No
How do you plan to manage this?
*
If nobody in the household has pet allergies, type N/A
Do you have other pets?
*
Yes
No
Please list your other pets. Include species (dog,cat, etc..), breed, age, and whether the animal is spayed/neutered.
*
If you do not have other pets, type N/A
Do you currently have a veterinary clinic that you use?
Yes
No
If yes, Name and Phone Number
Have you ever been involved with the animal control department? If yes, explain the circumstances.
If you move in the future, what will you do with this pet and your other pets?
Why do you want to adopt this pet? (select all that apply)
*
Companion
Hunting
Family Pet
Gift for friend/family
Protection/Guard Dog
Other
Will this pet be primarily kept indoors or outdoors?
*
Indoors
Outdoors
Both
A shelter is an insulated structure that has bedding inside. Shelter keeps pets warm in the winter, cool in the summer and gives them room to stand up, stretch out, and lie down comfortably. If kept outside, will your pet have shelter?
Yes
No
If yes, Describe the shelter
How will you keep this pet confined to your property?
*
Will be indoors only
Kennel
Fenced Yard
Invisible Fence
Tie out
Did you know that in the first year, regular preventative vet care my cost $500+ for a dog or cat?
Yes
No
Did you know that in the first year, pet food and pet supplies may cost $500+ for a dog or cat?
Yes
No
Can you afford veterinary care, grooming, emergency expenses, supplies, and food for the lifetime of this pet?
*
Yes
No
It may take two weeks or more for this new pet to adjust to your home (depending on teh household). Are you willing to give ample time for adjustment?
Yes
No
All pets making the transition from the shelter to a new home need time to adjust to a new family and may require housetraining and behavior training. Are you willing to provide any training needed?
*
Yes
No
Information regarding the history, health, and behavior of adopted animals may not be available or accurate. What behaviors would you be unwilling to work with?
*
What reasons might cause you to return this pet?
*
By signing below, I certify that the information I have given is accurate and complete. I recognize that any misrepresentation of facts may result in loss of privileges of adopting a pet. I understand that the Stephen Memorial Animal Shelter has the right to deny my request to adopt an animal, and I authorize investigation of all statements in this application. I understand that this application is property of the Stephen Memorial Animal Shelter
*
First
Last