Thank you for looking at adopting from Clarke County Animal Shelter.

ADOPTION APPLICATION FORM

I’m delighted that you want to take me home! First the staff here would like to know more about you and the kind of life we’ll have together.

The questions on this application are not a test. They’ll simply help the Clarke County Animal Shelter make sure you’ll take care of me. For example, I should receive veterinary care when I need it, and I require regular, nutritious meals. I also need shelter and supervision so I don’t run away and become part of the large population of stray animals.

I have a few requirements before you can adopt me. You must:

1         Be at least 18 years old            

2        Have valid identification with your current address

3        Make sure all the adults living in your household know about me and agree that I can live there

4        Provide the landowners name and telephone number

The Clarke County Animal Shelter reserves the right to refuse any pet adoption. Adoption fee required at the time of application.  If your application is denied, your fee will be refunded.

Section I – Getting to Know You

I want to know all about you and my new surrounds tell me more about yourself

Name: Mr. Mrs. Ms.______________________________Name of pet interested in:__________________

Address: _____________________________ City: __________________________________________

County: __________________________________ State: ______________________Zip:____________

Email: ____________________________________Phone:_____________________________________

Where do you live?  (Circle one)   House          Condominium              Apartment                      Dorm

                                    Farm                             Mobile home         Do you rent the lot Y / N

Do you            Own                     Rent                  Live with parents

Landowner’s name: ____________________________________________________________________

Landowner’s address:______________________________________________Phone:________________

Have you ever adopted from CCAS before?  Yes    or    No

Section II – Tell Me About My New Family

I’d like to get to know all about the members of my new family.

1) How many adults live in your household? __________________________________________________

2) How many Children? ___________________What are their ages? ______________________________

3) What will my role in the family be? Please circle all that apply.

   Companion       Gift      To breed            For a child         Watch Dog        Companion for another pet                                                 Business mascot              Hunting dog        Barn Cat

4) Who will be responsible for feeding me? __________________________________________________

5) Who will be responsible for training me? __________________________________________________

6 a) Have you had pets within the past 5 years? Y / N

     6b) Are there any pets in the home now (include pets kept outdoors)? Y / N

Type/Breed

   Where Kept

Age

Spayed/Neutered

Vaccinated

Still Own

   If no, why not?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7) If you have pets now or had them in the past, who was the veterinarian? __________________________________________________________________________

8) If you have a pet now, when was it’s last trip to the veterinarian? __________________________________________________________________________________

Reason: ____________________________________________________________________________

9) Does anyone in the household have allergies?   Yes       No

10) If you move in the future, what will you do with me and your other pets? _________________________

11.) A representative of the CCAS would like to make a follow-up visit to see how I’m settling in to my new home. What would be a convenient time to call? ______________________________________________

 

Section III – Raise Your Right Paw and Repeat After Me.

By signing below I certify that the information is true and that I will recognize that any misrepresentation of facts may result in my losing the privilege of adopting or keep an adopted pet.  I understand that the CCAS 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 the property of the Clarke County Animal Shelter.

Signature___________________________________________________________

 

Thank you for changing my life! Now, can you help my friends?

The Clarke County Animal Shelter is helping my friends and I find happy homes but we could use your help.  It costs a lot of money to keep the shelter running.

Please accept my gift of:         $25           $50                   $75                   $100                

Other: $_________

 

FOR OFFICE USE ONLY   Applicant Interviewed Date: ___________ By: ___________

Was the adoption approved?  Yes      No 

 If no why not? ________________________________________________________

Landowner’s Name: _____________________________________________________

Date notified: ______________By: ________________________________________

Did the landowner give approval?  Yes     No   If no, why not? ______________________

Other comments: ______________________________________________________

Dog intro approved by: __________________________________________________

Denied due to: ________________________________________________________