Dog Sumter SPCA

1140 South Guignard Drive

Adoption
;.,
Sumter, SC 29150

Application (803) 773-9292 (Phone)

(803) 418-0091 (Fax)

Name: Daniel and Natalia Avellaneda Date: 04-22-2020

Physical Address (No P.O. Boxes): 5806 Fish Rd City: Dalzell State: SC
Zip Code: 29040 Home: Phone: 321-831-0408 Work: Civil Engineer at Shaw AFB
Employer: USAF Email: [email protected] [email protected]

Name of Pet or Description: Dusty Age of Pet: 1 year

How did you learn of this particular pet? Stopped In ✓ Website Newspaper Friend

1. Do you currently live in a ✓ House  Apartment  Duplex  Mobile Home  Other

2. Do you currently  Rent ✓ Own  Lease the residence where you live  Live with your parents

3. How long have you lived at your current residence? 21 days We just bought the house!

Landlord’s Name: Daniel and Natalia Avellaneda Phone: 321-831-0408

4. How many adults live in your home? 2 How many children? 0

5. Does anyone in your household have pet allergies? ✓ YES, cats  NO

6. Who will be primarily responsible for the care of this dog? Both, Daniel and Natalia

7. Will this pet be living at your residence? ✓ YES  NO If no, explain

8. Is this dog a gift?  YES ✓ NO If yes, for whom?

9. What size dog are you looking for?  Small  Medium ✓ Large  Extra Large

10. Which of the following best describes your reasons for wanting this dog? (Check all that apply)

✓ Companion  Guard Dog  Hunting  Obedience Training

Agility ✓ Jogging/Walking Buddy ✓ Couch Warmer  Child’s Pet

✓ Other: company for our other dog

11. Will the dog be kept ✓ Inside  Outside  Other

12. If this dog will be kept outdoors, what kind of shelter will be provided?

13. How many hours will the dog be alone each day? 4-6 hours

14. Where will the dog be kept when no one is home? Cage for dogs
15. Where will the dog be kept at night? Cage for dog / Our room
16. Do you have a fenced in yard? ✓ YES  NO

17. Is your yard fenced on all sides and completely closed in? ✓ YES  NO

18. ✓ Entire Back Yard  Entire Front Yard Both  Three Sides Only Two Sides Only Pen/Size

19.  Wooden (Privacy) ✓ Chain Link  Other

20. How high? 4’✓ 5’ 6’ Other

21. If you do not have a fenced in yard, how do you plan to contain the dog in a safe and secure manner and provide the proper
exercise?

22. Have you ever adopted from us in the past?  YES NO✓ Do you still have the pet(s)? ✓ YES  NO

If NO, please state why.

23. Please list ALL the pets you have had in the last 10 years, adopted or not, living or deceased, and answer ALL questions:

Breed Age Sex Spayed/ Years Does this pet still live with you? If no, why?
Neutered Owned
Bernese mountain 1year Male NO 1year Yes, Bruno lives with us now
Dog

24. If you have other pets, are their vaccinations current? ✓YES  NO
Who is your regular veterinarian? Animal Medical Clinic

25. Do you give us permission to check your current or past pet’s medical history with your veterinarian? ✓ YES  NO

26. Under what circumstances would you NOT keep this dog? If he does not get along with our current pet
27. If you relocate, what do you plan to do with the dog? Moving out with him
28. If you go on vacation, etc, who will care for the dog while you are away? We take the dogs with us / Leave them with some friends
29. A pet lives from 12-20 years. Preventive veterinary care can cost from $100 - $200 or more per year. This includes booster vaccines and being
kept free of intestinal parasites, fleas and ticks. Additional expenses are heartworm preventative, food, and veterinary care in case of illness
or accident. Some shelters have unknown health backgroun3ds and behaviors.

Are you willing to give the love your new pet needs and to assume its financial and training or restraining responsibilities? ✓ YES  NO

30. Have you ever turned a pet into an animal shelter?  YES ✓ NO If yes, explain

PLEASE READ CAREFULLY AND SIGN BELOW I certify that the above information is true and correct to the best of my knowledge. I also acknowledge that
falsification of the above responses can result in the denied adoption of an animal to me or can result in the return to the Sumter SPCA of an adopted animal. I
understand and agree that the Sumter SPCA does not guarantee the health or temperament of the animal once it leaves the shelter. All dogs are required to be
spayed or neutered. I understand and agree to abide by the S.P.C.A. policy that states, “The S.P.C.A. reserves the right to refuse any adoption of any animal for any
reason deemed appropriate by the Sumter S.P.C.A.”

Signed: Date 04-22-2020

Notes (Office Use Only):

Please Carefully Read The Sumter SPCA Adoption Process and Policies:
Fees and Application:
Adoption fee for dogs and puppies is $175. Adoption fee for cats and kittens $75. An application is required for
approval prior to adoption. We will let you know if you are approved after reviewing your application. You can email
the application back or fax it to 803-418-0091.

What is Included:
Adoptions include the first set of vaccinations and deworming for all animals regardless of age. The new owner would
then be responsible for all other future vaccination requirements including boosters, rabies vaccines and deworming.

Spaying and Neutering:

All pets must be spayed or neutered by law. If the animal has already been spayed or neutered, then it can go home
immediately after the adoption process. If it is at least approximately four months of age or older, but has not been
spayed or neutered, we would perform the spay or neuter before it leaves our facility. It could then be picked up after
the surgery is completed. This surgery would be included in the adoption fee.

If it is a puppy or a kitten under four months of age, a deadline date will be given for the spay or neuter at which time
you are required to take it to your own personal veterinarian and to have the surgery completed. For puppies and
kittens, we will give you a voucher towards the spay or neuter. The vouchers cover the following: Female dogs and cats
are a $30 voucher. A male dog is a $25 voucher and a male cat is a $20 voucher. You would then pay the remainder of
the vet bill.

Holding Policy:
Due to the large number of inquiries for our adoptable pets, anyone coming from out of town that would like us to hold
an animal until they arrive will be required to:

1. Complete an Application and Be Approved.

2. Pay a holding fee of $25 to be applied at any time during our open hours from 11:00 AM until 5:00 PM.
This fee is NON-REFUNDABLE and is NOT APPLIED TO THE CURRENT ADOPTION FEE. If you choose this option AND
have an approved application, the payment must be completed over the phone at the time you make the request to
hold. Once the payment is made, there is NO REFUND WHETHER YOU CHOOSE TO ADOPT OR NOT. The animal will
then be held until you arrive before the end of that working day. If you fail to arrive by the end of the day, the animal
will again be put up for adoption. We DO NOT hold animals overnight.

I have read and understand the adoption process and holding policy for
adoption at the Sumter SPCA:

04-22-2020

Please Sign and Return in order for your application to be considered.

***The Sumter SPCA reserves the right to refuse the adoption of any animal for any reason deemed
appropriate by the Sumter SPCA.