Canine Adoption Application

CANINE ADOPTION APPLICATION

Are you interested in a specific dog(s)? If so, please list name(s)..

Name*

First Last

Date

Address*

Street Address Address Line 2 City State ZIP / Postal Code

Email*

Phone*

I am over 21?*

Yes
No

Personal Reference (cannot be a family member)

Relationship*

Name*

First Last

Phone*

Housing

Do You Rent or Own?*

Rent
Own

Residence Type*

What is your pet policy (if any?)*

Landlord/Management Name*

Landlord/Management Phone Number*

Describe Your Outdoor Space*

(Yard, Fence, Invisible Fence etc.)

Total Number of People in Household*

Adults (18+)*

Children*

Yes
No

If yes, please list:*

How many children and their ages

Has anyone in your household ever experienced animal-related allergies?*

yes
no

Who will be responsible for the dog's day-to-day care?*

When traveling, how will you provide for your dog?*

Are you currently employed?*

yes
no
retired

How many hours will the dog be left alone daily?*

Did you know that it costs about $2,000-4,000 per year to provide basic care for a healthy dog?!

Are you financially prepared to provide for the health and wellness of your new dog?*

Yes
No

If you are unable to continue to care for the dog, who will take over care?*

Have you ever rehomed a pet?*

yes
no

If yes, why?*

Under what circumstances would you not keep a dog (select all that apply)?*

Do you CURRENTLY have household pets?*

Current Household Pets Include: Species/Breed, Age, Sex, Altered (y or n), Vaccinated.*

Veterinarian Name*

Veterinarian Phone Number*

I'm looking for a:*

Puppy
Teen
Adult
Small-Medium
Medium-Large
Senior Small
Senior Medium-Large

We cannot guarantee the specific size of an animal as an adult. Is that a concern for you?*

yes
no

We cannot guarantee the specific breeds of any animal. Is that a concern for you?*

yes
no

Please select the options that you feel best suits you and your home.

The activity in my home is like:*

Where will your dog spend MOST of its time?*

If other, please explain.*

My dog needs to be good with (select all that apply):*

Dogs
Cats
Birds
Livestock
Traveling
Children

Have you ever worked with a dog trainer*

Yes
No

If yes, why and what methods were used for training?*

Are you willing to work with a trainer?*

Yes
No

If no, why not?*

What behaviors are you not willing to work with?*

Please let us know if you have any questions or concerns below:

How did you hear about us?*

Section Break

Consent*

I agree to SPCA of Westchester Inc.'s Assumption of Risky Policy.

I acknowledge and understand that interactions with animals carry inherent risks, including bites, scratches, and other injuries. I recognize that even well-tempered animals may react unpredictably and that SPCA of Westchester cannot guarantee my safety. I further understand that, if my personal pet(s) are present or otherwise come into contact with SPCA of Westchester animals during or as a result of this activity, such interactions also carry risks of injury or illness to my pet(s), and I accept full responsibility for any resulting harm.
In consideration Rembrandt being permitted to visit, I fully, knowingly, and voluntarily assume all risks associated with my participation and release SPCA of Westchester, its staff, board of directors, officers, and affiliates from any liability for injuries, damages, or losses, except in cases of gross negligence or willful misconduct. I agree to completely follow all verbal and written instructions given by SPCA of Westchester staff and understand that failure to do so may result in termination of my visit. Additionally, I agree to indemnify and hold harmless SPCA of Westchester from any claims arising from my actions during my visit.
By signing below, I confirm that I have read, understood, and voluntarily agree to this Assumption of Risk, Release, Waiver of Liability, and Indemnity Agreement.

Signature*