ADOPTION APPLICATION
PHONE: 804-732-3654 FAX: 804-862-3571
Please copy and paste this application into the body of an email (or alternatively as a Word Document), complete the application, then send the completed application to petersburganimalshelter@yahoo.com
You may alternatively fax the application to 804-862-3571
Bringing a new animal into your family means major adjustments for everyone. Are you prepared to give an animal the best care for the next 10 years or more?
To help ensure the best possible placement of our animals, and in order to determine that the proposed adoption is in the best interest of the animal, you, and your family, please compete each of the following questions. Please be as thorough as possible. The Petersburg Animal Shelter reserves the right to refuse adoption to any applicant.
Animal You Wish to Adopt:
Pet Name Dog Cat Other Breed
Your Name: Spouse’s Name:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Cell Phone:
Place of Employment:
Military: Yes No
Name Personal Reference:
Relationship:
Phone:
How did you hear about us (if it was a website, please list specifically):
Household Information:
1. Do you live in a house, apartment, condo, mobile home, or on post?
2. Do you own, rent or live at home?
3. If you rent, are pets allowed?
● Landlord’s name and phone:
● Does your landlord require a security deposit?
4. Length of time at current residence?
Less than 1 year (If selected, please provide previous address)
Previous Address:
5. If you are planning on adopting a dog, do you have a fenced in yard?
What type of fence (chain link, stockade, etc.)?
If you do not have a fenced yard, what arrangements do you plan to make for exercise and toilet duties?
6. Number of children in home:
Age of children:
7. Have allergies to animals been a problem to any household member:
Pet History:
1. Do you own other pets?
Total number of animals:
If yes, please complete information below.
Name, age and breed of each pet?
Are they current on their vaccinations?
Are your dogs on heartworm preventatives?
Do your cats go outside?
2. Have you had other pets in the last five years?
What happened to them?
3. Have you ever given up a pet for adoption?
If yes, please explain the circumstances:
4. Which veterinary clinic do you use?
5. Vet phone number?
6. Where will you keep the dog when you are home? 7. Where will you keep the dog when you are not home (i.e. work, personal outings)? 8. Where will the dog sleep at night?
Adoption Requirements:
1. If you adopt a puppy or a kitten, you’re required to sterilize him or her by 4 months of age.
2. If adopting a cat, are you planning to declaw him/her?
Are you planning to let the cat go outside?
3. How much do you think this pet will cost you each year (please include food, heartworm preventative, flea control,
medical and dental care, supplies, training, grooming, boarding costs and toys)?
4. If adopting a dog, you will abide by all companion animal laws (leash, tags, etc.)
You are responsible for providing proper shelter, food, water, exercise, medical care and humane treatment at all times
for your companion animal.
5. You must return the animal to us if you feel you cannot keep him/her. You must not sell the animal or give it to anyone
else.
I certify that the information given on this application is true and correct. If I am approved to adopt an animal, I agree to all the above requirements. I understand that failure to comply with any of the requirements will result in confiscation of adopted animal. My signature on this application indicates my agreement to a criminal background check.
Signature of Applicant(s) (electronic signature acceptable)
SIGNATURE: DOB:
SIGNATURE DOB: