Email Address:
What is the NAME of the animal for which you are Applying?
What is the DATE that you are filling out this Application?
Full Name:
Full Mailing Address
Telephone Number
Work Telephone Number
Cell Number
Spouse/Partner's Name
How Long Have You Lived at the Above Address?
Do You? Rent? Own? Live with Parents?
Do You Live In? A House? An Apartment? A Townhouse? A Trailer/Mobile Home?
(b). If You RENT, Are you Permitted to Own Pet?
(c). If You RENT, Please provide you LANDLORD's Name and Contact Information.
Regarding Work, Please Select ALL that Apply.
Will the Animal be left Alone on a Regular Basis throughout the Week?
(b). If YES to above question. How long will your pet be left alone Daily?
When you are at home, WHERE will your pet be during the DAY and NIGHT?
How many Adults live in your Home?
How many Children live in your Home? Please list all children's ages.
Please check ALL that Apply. I want to Adopt a pet for...
List ALL of the Pets you have owned for the past 10 years. List: NAME, BREED, MALE/FEMALE, INDOOR/OUTDOOR, SPAYED/NEUTERED, AGE, IF STILL OWNED (example: Fluffy, Cat, Female, Indoor, Spayed, 8 yrs, yes)
(b). If you DO NOT still own any of the animals listed above, please give a brief answer as to why you do not own them and how long it has been since you owned them.
What is the Name of the Veterinary Clinic that cares/cared for your pets?
If any of your pets HAVE NOT been Spayed/Neutered, please indicate why?
Have your current pets been vaccinated within the last year? If NO, please indicate why?
Have you had a pet die within the past 3 months from a contagious disease or unknown cause? If YES, please describe.
Have you Ever Adopted a pet from the Burin Peninsula SPCA? If YES, please let us know if you still own this animal.
Does Anyone in your Home suffer from Asthma or Other Pet Related Allergies?
(b). If YES to the above question. How will you handle this situation? Or if allergies develop within your home what will you do with your pet?
If you must MOVE what do you plan to do with your pet?
What do you intend to do if you go on Vacation, take an Unscheduled Trip or have a Family Emergency that takes you away from Home?
Do you plan to Board/Kennel your pet? If YES, what do you believe will be the cost of this service?
What do you expect will be the costs of the following: FOOD (Monthly), VACCINATIONS (yearly), LICENCE (yearly), EMERGENCY MEDICAL CARE
What type of ID do you plan to use for your pet?
Pets need time to adjust to new surrounding. Are you Prepared and Willing to give your new pet ONE MONTH to adjust to your home?
How Long have you been Planning on Adopting a pet?
What do you believe is the Life Span of this Animal?
Do You Intend to Keep this Animal for its Lifetime?
(a). If you are Applying for a Cat, Your cat will it be an ...
(b). What will you do if the CAT gets on the Counters?
(c). What will you do if the CAT scratches the furniture?
(d). What will you do if the CAT chews on your houseplants?
(e). What will you do if the CAT messes outside the litter pan?
(f). What will you do if the CAT keeps you awake at night?
(g). What will you do if the CAT jumps in the baby's crib?
(a). If you are Applying for a DOG, Your dog will be an ...
(b). Do you plan to Tie your DOG Outside? If YES, please indicate for how long.
(c). How many times a day do you plan to Exercise/Walk you DOG?
(d). How do you plan to Housetrain your DOG?
(e). Do you have a Fenced Yard?
(a). The Burin Peninsula SPCA requires 3 References. References CANNOT be family members. Reference #1: Name & Telephone:
(b). Reference #2: Name & Telephone:
(c). Reference #3: Name & Telephone
How did you find out about this animal up for adoption?
Animals Adopted from the Burin Peninsula SPCA CANNOT be sold or given a new home without notifying and gaining permission of the SPCA. Do You Agree to these Terms?

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