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Fillable-Adoption-Form-1-1

The document is an Animal Adoption Questionnaire from Special Pals Shelter, requiring potential adopters to provide personal information, details about their living situation, and their experience with pets. It emphasizes the importance of responsible pet ownership and asks specific questions to assess the suitability of the adopter for the animal they wish to adopt. The form must be completed and submitted before visiting the shelter or can be emailed to the provided address.

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2 views

Fillable-Adoption-Form-1-1

The document is an Animal Adoption Questionnaire from Special Pals Shelter, requiring potential adopters to provide personal information, details about their living situation, and their experience with pets. It emphasizes the importance of responsible pet ownership and asks specific questions to assess the suitability of the adopter for the animal they wish to adopt. The form must be completed and submitted before visiting the shelter or can be emailed to the provided address.

Uploaded by

ownstructure
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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SP # __________________________

3830 Greenhouse Road


Houston, TX 77084
● .specialpals.org

Animal Adoption Questionnaire


Please bring this completed form when visiting the shelter or email it to [email protected].

Name ___________________________________________ Email __________________________________________________

Address _________________________________________ City ______________________________________ Zip __________

Primary Phone ___________________________________ Alternate Phone ________________________________________

Driver License # __________________________________ Name of animal interested in_______________________

Currently employed? □ Yes □ No


Will you be the person financially responsible for this animal? □ Yes □ No

Thank you for considering the adoption of a shelter animal! Before you decide to adopt, please consider the
time, effort and funds necessary to provide proper care of an animal. Responsible pet ownership requires a
commitment to provide care and companionship for the life of the animal. The decision to adopt a pet is an
important one. In order to ensure that you and your pet will be happy for years to come, please take a few
moments to carefully read and complete this application. Your answers are very important.

Have you adopted from Special Pals Shelter before? □ Yes □ No If yes, which animal? _________________
Do you still have the animal? □ Yes □ No If no, please explain why: _____________________________________
Do you currently live in a □ House □ Apartment □ Condo □ Other _____________________________________
Do you currently □ Own □ Rent □ Lease
How long have you lived at your current residence? ________________________________________________________
If you are not the property owner, Special Pals, Inc. must verify the property owner’s current pet
policy.

Landlord’s Name ____________________________ Phone Number _________________________________________

How many adults live in your home? _______ Children? _________________ Ages _____________________________
oes anyone in yo r ho sehold have allergies □ Yes □ No

ho ill be primarily caregiver of this animal


Is this animal a gift □ Yes □ No If yes for hom
lease describe yo r reason(s) for anting to adopt this animal. ( ogging b ddy co ch armer
companion etc.)

o many ho rs ill the animal be alone each day


here ill the animal be ept hen no one is home
here ill the animal be ept at night
o yo have a fenced yard □ Yes □ No eight of fence ype of fence
If yo have other pets in the home Vaccinations c rrent □ Yes ■ □ No rrently licensed □ Yes □ No
o yo have a reg lar veterinarian □ Yes □ No Vet’s Name
nder hat circ mstances o ld yo not eep this animal
Please list all of the pets you have had in the last 10 years, including current pets, and those you no longer own.

Species Breed Age Sex Altered Owned how Still own? If no, why not?
M/F Y/N long?

I prefer animals that are: □ Small □ Large □ Any Size

Please describe the temperament and activity level you are looking for in a pet. Check all that apply:
□ High Energy □ Outdoorsy □ Lap Animal □ Mellow □ Affectionate □ Quiet □ Guard Dog

I prefer an animal that: (Check all that apply)


□ Loves children and strangers □ Tolerates children and strangers □ Loves other animals
□ Tolerates other animals □ I have no preference if the animal gets along well with other
animals

When it comes to relating to animals, I tend to be more:


□ Strict and demanding (the animal must work for treats)
□ Moderate (encourage good behavior, ignoring bad)
□ Lenient (the animal looks cute, so he/she gets the reward even without good behavior)

Is anyone living in your home nervous around or unsure of animals?


□ Very (e.g. bitten as a child) □ Moderately □ Some (no experience with animals) □ N/A

The noise/activity level in my home is usually: □ High □ Medium □ Low

I would enjoy brushing or grooming my animal: □ Rarely □ Occasionally □ Daily □ Weekly □ Monthly

My ideal animal would: ___________________________________________________________________________________


Bad animal habits I can’t tolerate include: _________________________________________________________________

I certify that the above information is true and correct. I understand that false information will deny this adoption
immediately. By signing this application, I understand and have been notified that Special Pals, Inc. reserves
the right to deny or refuse any application without dispute or conflict. I understand that Special Pals, Inc.
reserves the right to inspect my home prior to approving the application. I agree to release any/all of my pets’
previous and current veterinary records to Special Pals, Inc.

Signed _______________________________________________________________ Date _____________________________

Reviewed by (SP Staff) ________________________________________________ Date _____________________________

Approved / Denied (list reason) on (date) & by (initials):


______________________________________________________________

Notes, attempts to contact, and Vet / Medical history verification (STAFF USE ONLY: INITIAL AND DATE NOTES):
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
______________________________________________________________________________

Submit Application Reset Form

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