Adoption Form Please fill out this form in its entirety to the best of your ability. Any missing information may delay the application process. Date Filed Animal Number Animal Name Animal Sex: Male Female Your Name Home Phone Work Phone Cell Phone Street Address City State Zip Code Co-Applicant Email Address Are you 18 years of age or older? Yes No Have you ever adopted an animal from this shelter? Yes No If yes, when? What was the outcome? Please list all animals you have owned in the past five years: Type of Animal Name of Pet Sex Age Spayed orNeutered Housed Inside or Outside Still Own? MF YesNo YesNo MF YesNo YesNo MF YesNo YesNo MF YesNo YesNo MF YesNo YesNo What is the name of your Veterinarian What is the location and phone number of your vet? Why do you want to adopt a pet? Have you ever given up ownership of a pet? Yes No Why? Do you live in a: Single Dwelling Apartment Mobile Home With Parents Are you planning to move in the next 6 months? Yes No If you move, what will you do with your pet? How many people reside with you? How many are children? List children and their ages Does anyone in the home have allergies? Yes No How many hours will the pet be left alone? How will the pet be confined during that time? How will the pet be confined at night? Who will be responsible for the care of the pet? Are you full aware of and financially prepared to deal with the costs associated with owning an animal (ie: Vaccinations, quality food, litter, etc. as well as veterinary expenses due to illness or emergencies)? Yes No What would you consider to be a realistic cost to properly care for an animal for one year? Because it is very stressful for an animal to go from home to home, we hope to place each one in a caring home for the rest of its life which could be up to 20 years. Are prepared to make this commitment? Yes No What kind of dog/cat behavior do you find unacceptable? How many hours per day will you realistically be able to commit to this pet? For what activities? How did you hear about the Clearfield County SPCA? I understand that you will be contacting my veterinarian for the vaccination and helath history of the pets I currently own or have owned in the past. I release, through my submission of this application, my veterinarian to provied that information to you. I Understand I certify that all of the information in this application is true, and I understand that false information may void this application. I Understand The form will clear if your information has been successfully sent.