OUR SPCA CANNOT ACCEPT YOUR APPLICATION FOR VIEWING OR
ADOPTION OF A PET UNTIL YOU PROVIDE ADOPTION COUNSELOR WITH: 

1.)           NYS DRIVERS LICENSE WITH PRESENT ADDRESS (NO P.O. BOX)

2.)           1 ADDITIONAL FORM OF I.D. WITH PRESENT ADDRESS

3.)           YOU MUST BE 21 YRS. OR OLDER TO ADOPT A PET

              PLEASE SUBMIT YOUR IDENTIFICATION WITH THIS APPLICATION

 NAME                                                                                              

ADDRESS                                                                                                                           

CITY/STATE/ZIP                                                                                                                                                           

PHONE:                                               E-MAIL ADDRESS                                                                               

EMPLOYER NAME:                                                                                                                                             

HOW MANY ADULTS IN HOME?         NUMBER & AGES OF CHILDREN?                                     

ARE ALL MEMBERS OF HOUSEHOLD AWARE OF THIS ADOPTION & IN AGREEMENT

ON THIS PET?                               CAN WE CONTACT THEM ?                                                               

 HOW MANY PETS DO YOU OWN PRESENTLY?  DOGS                        CATS                        

ARE THEY NEUTERED/SPAYED?                NAME OF VET YOU CURRENTLY SEE, OR

HAVE LAST SEEN                                                                                                                                  

 WHAT TYPE OF HOME DO YOU LIVE IN (CIRCLE)  FARM   HOUSE    APT.    MOBILE HOME

 DO YOU HAVE A FENCED IN YARD ?                                                                                                       

IS SHELTER OR DOGHOUSE PROVIDED WHEN DOG IS OUTSIDE?                                              

DO YOU PLAN ON ALLOWING YOUR ADOPTED CAT OUTSIDE?               WHY?                      

IF THIS PET BECOMES ILL, ARE YOU FINANCIALLY CAPABLE OF PROVIDING

VET CARE?                                                                                                                                                                       

 DO YOU OWN YOUR HOME ?     YES                        NO                 

IF YOU RENT, DOES YOUR LANDLORD ALLOW PETS ?     YES                     NO               

IF YES, WHAT IS LANDLORD’S NAME & PHONE #                                                                              

YOUR LANDLORD WILL BE CONTACTED IMMEDIATELY AND/OR YOU ARE

REQUIRED TO SHOW A LEASE STATING THAT YOU ARE ALLOWED TO HAVE PETS.

DO YOU LIVE WITH YOUR PARENTS ?  YES       NO      ARE THEY THE OWNER OF

THE PROPERTY ? YES     NO     YOUR PARENTS WILL BE CONTACTED IMMEDATELY.

 I VERIFY THAT THE ABOVE STATEMENTS ARE TRUE. I ALSO UNDERSTAND THAT

THE SPCA RESERVES THE RIGHT TO SUSPEND MY ADOPTION APPLICATION FOR

FALSE INFORMATION. I GIVE THE SPCA PERMISSION TO VERIFY MY RESIDENCE,

INCLUDING A NEW HOME CHECK.  I ALSO GIVE THE SPCA PERMISSION TO VERIFY

PRIOR & CURRENT PET OWNERSHIP, & MEDICAL STATUS WITH THE VET’S OFFICE

THAT I LISTED ABOVE.

 _____________________________________________                                                                             

SIGNATURE                                                                                                                      DATE