Ohio SPCA

Name:

Date:

Home Address:

City:

State:

Zip:

E-mail Address:

Home Telephone:

Work Telephone:

Type(s) of animal you would you like to adopt (i.e. cat, dog, pig, goat, horse, etc.):

Have you ever adopted from Ohio SPCA before?

Please list your reason for wishing to adopt an animal

Describe the housing/fencing you will be using for the animal(s)
at your residence:

How long have you been looking for a pet?

Is this pet going to be a gift?

Are you at least 18 years of age?

Do you own or rent your current place of residence?

If you rent, we will need a copy of the lease, the landlord's phone number, and you will need to verify that you are permitted to have a pet where you live.
How long have you lived at your current residence?

Will you be moving anytime soon?

If yes, please give your new address and phone number:

Do you have children?

If yes, what are their ages?

Have your children been around pets before?

Does anyone in your household have allergies to animals?

Current number of pets (ages, sex, species, breed, spay/neuter, vaccinations):

Veterinarian Information:

Vet's Name:

Clinic Name:

Street:

City:

State:

Zip:

Telephone number:

Other Vets you have used:

General Questions:

1. Are you willing to accept full financial responsibility for your pet?

2. Are your pets current on all inoculations? Are they spayed/neutered/gelded?

3. Who will provide care for your pet in your absence?

4. Do you object to an Ohio SPCA volunteer visiting your home or calling you to check up on your adoptive pet?

5. Please provide two references that we may contact:

Ohio SPCA reserves the right to correspond with adopters and conduct on-sight inspections of adopted animals housed at your residence.

We also sign a mutual adoption contract which grants Ohio SPCA the legal right to resume custody of adopted animal(s) if the adoption terms are violated in any way.

(For purposes of this application, printing your name constitutes a signature.)
I, the undersigned Adopter, hereby declare that the information provided in this adoption evaluation is true and correct to the best of my knowledge and belief.
Any false information may result in nulifying the adoption.

Signature:

Date:

This is a foster contract. Only upon the release of animals by the court will any adoption become final.