Referral Pet
**These animals are not associated with
Carolina Animal
Protection Society**
Please provide the following information
1. Applicant Information
Name
Address
City, State, Zip
Phone Number
Employer
Position
Work Phone
Email Address
Date
Which animal are you interested in:
2. Questionnaire
Why do you want to adopt?
Do you live in House Townhouse Apartment
Duplex Military Housing
Do you own or rent Own Rent Military Housing
If you rent, what is the name and phone number of your landlord
Do you have a fenced yard Yes No
Type and height of fence
Where will this pet be kept during the day
Where will this pet be kept during the night
How many adults are in the household
How many children are in the household
What are the ages of the children
Anyone home during the day Yes No
If yes, who
Anyone in the house have allergies Yes No
Who will be responsible for caring for this animal
How many hours will this pet be alone during the day
Will the dog be tied outdoors at all Yes No
Under what circumstances would you give up your dog Moving Divorce
Dog is ill New Baby Behavior Other
If behavior or other, please explain
Who will care for this animal when you go on vacation
Are you willing to spend time training the dog to deal with problems such as jumping up, barking,
house training, and pulling on the lease Yes No
Do you plan on taking obedience class Yes No
Have you ever had a pet die at an early age due to an accident Yes No
If yes, please explain
How will you exercise the dog and where
Name and phone number of your vet
Are you or your spouse in the military, if so, what would you do if you were transferred or receive
deployment orders
Please list any comments or preferences you may have
If for any reason you should be unable to care for this pet, what would you do with him or her?
What do you think are the responsibilities of having a pet?
If the pet you are interested in is not spayed/neutered, do you plan on having that surgery done soon?
Yes No
If
the pet you are interested in does not have current vaccines, do you plan on
getting them done right
away?
Yes
No
Do you ever plan on doing any of the following to this animal?
Breeding Fighting Selling
3. Please list the pets you currently own and have owned in the past including the type, sex, age, if they
were spayed/neutered, and where the animal is now
a.
b.
c.
d.
e.
**The
animals applied for are a courtesy listing for Carolina Animal Protection
Society in hopes of assisting the Placement Families on finding good home for
their
pets, but are not the responsibility of the above organization.**
For
Placement Families
It is strongly recommended that applications be taken for animals in need
of good homes. Also, it is strongly recommended that the Placement
Family perform home visits for the pet's possible new family. If you would
like more information on doing home visits please ask a CAPS representative
For
Adoptive Families
Should
you adopt the above animal, ask for any medical records including
vaccine history, spay/neuter info and flea or heartworm preventative
treatments. Please understand that the Placement Family wishes only the
best for their pets and may want to take some time to look over your
application. You should utilize that time to consider whether or not you
are
truly ready for the responsibility of that pet.
This
space is for any agreements between the Placement Family and the Adopting Family
such as
spay/neuter dates, vaccine dates and arrangements should things not work out
with the pet
Date
Signatures
Adoptive Family
Placement Family