ADOPTION APPLICATION

Date: ________

Animal Name: _______________ Breed:________________ Age:_________________

Color__________________________ Sex___________ID #: _________________

Cash____ Ck____ Credit____ Fee_______

Name __________________________________________________________________________

Address_________________________________________________________________________

City______________________State_______________Zip________________

Drivers License #: ____________Occupation_______________________

Home Phone__________________________________

Cell Phone__________________________________

Email Address__________________________________

How long have you lived at this address? ____________ Do you _____own ______rent?

What type of home do you live in- house, condo, apartment, mobile home, farm

If you rent, please provide the name and phone number of the landlord:

Name____________________________________Phone #___________________________

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1. How many adults and children living in the home? Age of children? _______________

2. Is everyone in the home in agreement with the decision to adopt a dog/cat? _______________

3. Do you have time to provide adequate love and attention? _______________

4. Please list the pets you own:

SEX BREED AGE SPAYED/NEUTERED

5. Are these pets current on vaccines? _______________

6. Have you ever surrendered a pet?

If so, why?_________________________________________________________

___________________________________________________________________

7. How do you discipline your pets? __________________________________

8. Where will the dog/cat spend the day? __________________________________

9. Where will the dog/cat spend the night? __________________________________

10. List the number of hours on average that the dog/cat will spend alone per day.
__________________________________

11. Who will have primary/financial responsibility for this dogs/cats daily care?
__________________________________

12. Do you agree to provide regular health care by a licensed Veterinarian?______

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13. All animals adopted shall be spayed/neutered by 6 months of age. (Initial) ___________

14. Do you agree to provide a fenced in area for your dog when it is outdoors? If no fence, what
other type of containment will you use?
_________________________________________________________________________________

_________________________________________________________________________________

15. Do you agree to keep your cat primarily as an indoor pet? _______ If you allow your cat to
go outside, do you agree to monitor him/her carefully?__________

16. You agree to contact the Animal C.A.R.E. Foundation if you can no longer keep this
dog/cat? (Please initial) ______________

17. ACF reserves the right to withdraw this animal from your home if we determine its needs
are not being met adequately. (Please initial) __________

18. Do you have a regular veterinarian? ____Yes ____No

***Vets Name:___________________________________________________

Address:__________________________________________________________

City:___________________State:______________Zip:__________________

Phone number:________________________________________________________

***Please list a non-relative who is familiar with you and your pets.

Name:_____________________________________________________________

Address:___________________________________________________________

City:______________________State:_________________Zip:_______________

Phone number:_____________________________________________________

Relationship to you:_________________________________________________

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A representative will call in one week for follow-up and make a home visit if needed, prior to
and/or following this adoption.

This dog/cat will reside in my home as a pet. I will provide it with food, fresh water, shelter,
affection, annual physical examination and vaccinations under the supervision of a licensed
Veterinarian.
I agree to hold the Animal C.A.R.E. Foundation harmless to the risk of being bitten, scratched,
or injured and to any damages to my property by this adopted animal. All of the information I
have given is true and complete.

_________________________________________________________________________________
SIGNATURE DATE

Revised 2/14/17

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 SPAY/NEUTER AGREEMENT

I ______________________, agree to have puppy/kitten spayed or neutered

by the date that the Foster Care/Adoption Coordinator of the Animal C.A.R.E.
Foundation designates.

The Foster Care/Adoption Coordinator will call and arrange for your pet to be
spay/neutered at the vet/clinic of our choosing (this spay/neuter is covered by
the adoption fee) on a date before the animal reaches 6 months of age.

By signing this, you are acknowledging that you are to have this puppy/kitten
spayed or neutered on the date determined by the Animal C.A.R.E.
Foundation. Failure to do so will result in the reclaiming of the adopted animal
by ACF.

_____________________________ ___________________________
Adopter Signature Date

_____________________________ ___________________________
Foster Provider Signature Date
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