PO Box A East Smithfield PA 18817 Ph (570)596-2200
Fax (570) 596-2222
Email adoptions@animalcaresanctuary.org
Foster/Adoption Application (circle one) Date:______________________________ Name: __________________________________________________________________ Address: ________________________________________________________________ Home phone: ___________________________ Evening or Cell: ___________________ Email address: ______________________________ Drivers License #: ___________________________ State Issued: ____________ Employer:__________________________________ Veterinarian name:__________________________ Address: _______________________________ _______________________________ Phone #:________________________________ Length of Time Used: ______________ Current Pets: Name
Type
Name
Species
M/F
Age
Spay/Neuter
Previous Pets within the last five years M/F Age Spayed/Neutered
Had How Long
Had How Long
Where is pet kept?
What happened to pet?
If pets are not spayed or neutered please explain why not: _____________________________________________________________________________________ Do you own your own home? Yes____________ No_________________ If not, please provide landlord name and phone # or current living status:__________________________ _________________________________
Please describe your yard (size, type of fencing, no fencing etc)____________________________________________________________________________ How will you keep your dog confined on your property? ________________________________________ Why did you decide on this particular animal?_________________________________________________ What activity level are you looking for? (circle one) Active/ Friendly/ Quiet Why do you want this pet? (circle all that apply) Company for another pet, House pet, Mouser, Lap Cat, Breeding, Companionship, Guard dog, Gift, Companion, Hunting, Other_______________________________ Where will you keep your new pet during the day? ____________________________________________ Where will you keep your pet at night?______________________________________________________ How many hours will your new pet be alone each day? ___Less than 3 ____ 3 to 6 _____ 6 to 9 _____9 to 12 If you will be gone more than 8 hours, and you are applying to adopt a dog, what arrangement will you make for the dog? ________________________________________________________ ______________________________________________________________________________ How do you plan to housetrain your pet? _______________________________________________ How would you handle any behavior problems? (ie biting, chewing, barking, etc)___________________________________________________________________________________ ______________________________________________________________________________________ What problems do you think you will have when you take this animal home? _________________________________________________________________________________ Please list the people residing in your home including yourself: Name: Relationship:
Age:
Does anyone living in the household have any known allergies to pets? Yes/ No What will you do with this pet if you need to move?___________________________________________ Who will be walking this dog in the morning and night?________________________________________ How long will you walk?__________________________________________________________ Who will be feeding/watering this dog?_______________________________________________ Please provide three personal references and include two NOT RELATED to you:
Name
Address
Phone
Relationship
Name of Pet you are interested in Adopting: _____________ Type: Dog Cat Or, I am interested in adopting a ___ Male ____Female, ___________, between the ages of _____ and _____. Do you understand that Animal Care Sanctuary makes no representations or guarantees of the temperament and health of any animal from ACS? Yes/ No Do you understand that Animal Care Sanctuary is in no way liable for any future injury or damage caused by this animal? Yes/ No I/We have read and carefully answered each question on this Adoption Application and have provided truthful answers. I/WE understand that Animal Care Sanctuary will rely on the answers we have provided in going forward with the adoption process and, in the event that Animal Care Sanctuary learns that false information has been given, we may be denied the right to adopt an animal or any animal placed in our care by Animal Care Sanctuary may be required to be returned to Animal Care Sanctuary and all fees paid by us to Animal Care Sanctuary will be forfeited. I/We also understand that we may be denied the right to adopt an animal if our references to not meet Animal Care Sanctuary standards or if Animal Care Sanctuary determines that our home is not appropriate for a specific animal we prefer to adopt. To expedite the application process, please contact your veterinarian and give them permission to speak to Animal Care Sanctuary. In addition, by signing below you give consent for Animal Care Sanctuary to obtain information from your veterinarian(s). Adopter________________________________________ Date__________________________________________ Adopter_______________________________________ Date__________________________________________ Adoption Counselor _____________________________ Date__________________________________________ For Internal Use Only: Approved: Yes No Name of Animal Approved for: _______________________ Type of Animal: Dog Cat Bird Other________________________ Notes: ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________