Small Animal Online Adoption Application - SPCA Westchester, New York

SMALL ANIMAL ADOPTION APPLICATION

Are you interested in a specific small animal(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*

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

Are all household members in agreement with this adoption?*

yes
no

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

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

Are you currently employed?*

yes
no
retired

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

Did you know that it costs about $600-1300 per year to provide basic care for a healthy small animal?!

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

Yes
No

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

Have you ever rehomed a pet?*

yes
no

If yes, why?*

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

Current Household Pets Include: Species/Breed, Age, Sex, Altered (y or n), Vaccinated. If no current pets list NONE.*

Veterinarian Name*

Veterinarian Phone Number*

I'm looking for a:*

Rabbit
Ferret
Hamster
Guinea Pig
Lizard
Other

Is it your first time adopting this type of animal?*

yes
no

Are you familiar with this animal's diet and basic needs?*

yes
no

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

The activity in my home is like:*

Describe housing/enclosure you plan to use for the animal:*

Small animal housing and enclosures need daily cleaning. Are you ok with this?*

Yes
No

Can you keep the animal separate from other pets if needed?*

Yes
No

How much human contact and attention will this animal receive daily?*

What behaviors are you not willing to work with?*

Litterbox problems
Biting
Unsocial/Dislikes handling
Eats Live Prey
Other
None

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

How did you hear about us?*

Small Animal Adoption Application

SMALL ANIMAL ADOPTION APPLICATION

Personal Reference (cannot be a family member)

Housing

Did you know that it costs about $600-1300 per year to provide basic care for a healthy small animal?!

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