Spa Ohio Adoption/Foster Application

ADOPTION / FOSTER APPLICATION
STORE

ADOPTION / FOSTER APPLICATION

Are you applying to: *

Foster

Adopt

Name: *


First	Last

Your Age *

Spouse or Partner's Name

Pet's Name (that you wish to adopt) *

Home Phone: *

-
Area Code	Phone Number

Cell Phone:

-
Area Code	Phone Number

Work Phone: *

-
Area Code	Phone Number

Address: *

Street AddressCityState / Province / RegionPostal / Zip Code

E-mail: *

How long have you lived at this address? *

Any plans to move in the next few years? *

Yes

No

How many times have you moved in the last five years? *

Place of Employment *

How long employed there (years/months)? *

Reasons for adopting this pet *

Companion	Mouser	Family Pet	Gift
Barn Cat	Breeding	Guard Dog

I understand that annual shots and veterinary care can cost between $150 to $250 per year *

Yes

No

Are you able/willing to pay for emergency care, which could result in a bill of $200 to $1,000 or more? *

Yes

No

I am willing and able to accept the additional cost of owning a pet *

Yes

No

Everyone in my household knows I am adopting this pet *

Yes

No

Do you *

Own

Rent

Live with parents

Is it a *

House	Apartment	Condo
Mobile Home	Dormitory

Landlord's Name

Landlord's Phone Number

My Landlord allows pets

Yes

No

List the names and ages of everyone living in your household

List ages of children who visit your household

The pets will be kept *

Indoor

Outdoor

Indoor/Outdoor

Are there children who visit your household on a regular basis? *

Yes

No

How many hours a day will your pet be left alone? *

0-2	2-4	4-6
6-8	8-10	10-12
12-14

How many pets have you had in the three years? *

List Each of these Pets:
Name | Age | Gender | Species | Breed

All of my pets are up-to-date with shots/vaccinations *

Yes

No

Which of the above mentioned pets were spayed/neutered?

Which of the above-mentioned pets live with you currently?

What happened to the above mentioned pets that you no longer own?

For whom would you be adopting this dog/cat? *

Myself/My Family	My Child/My Children
Someone else

Does anyone in your household suffer from asthma or have allergies to pets? *

Yes

No

Describe your household activity/noise level *

High

Medium

Low

How often do you travel? *

Frequently	Occasionally
Rarely	Never

If you have a cat does it get along with dogs?

Yes

No

My current pets live

Indoor

Outdoor

Indoor/Outdoor

If you have a cat is it declawed?

Yes

No

Who will be the principle caregiver of this pet? *

If you have a dog does it get along with other dogs?

Yes

No

Who will be financially responsible for this animal? *

Veterinarian's Name

Veterinarian's Phone:

May we contact this vet?

Yes

No

Where will your new pet sleep ? *

I have a secure, fenced area(Large breed and active dogs require a fenced area) *

Yes

No

Describe fencing height

Describe fencing type

Chain Link

Privacy

Split Rail

Other

Does your fence have a gate with secure latch?

Yes

No

Does door to your house open directly into fenced area?

Yes

No

Have any of your pets have died from Leukemia, FIP, FIV, Heartworm, Parvo or other unknown causes in the last 3 months? *

Yes

No

If yes, please explain

What circumstances might justify giving up a pet? (check all that apply) *

Baby	Divorce
Dog not getting along with other pets	Moving
Allergies	New household member dislikes dog
Shedding	Behavior problems
House Soiling/Urine marking	Want to travel
Dog becomes ill	Destructive
Children lost interest	Too time consuming
None	Other

I have adopted from S.P.A. before *

Yes

No

Additional Comments

* Required Fields

By submitting this application I contend that I am capable of handling and interacting with the pet I propose to adopt, and I am prepared to demonstrate this to the satisfaction of S.P.A. I further understand that completing this application is not a guarantee that I will be approved for adoption of this particular pet, and S.P.A. has the right and responsibility to deny any adoption.

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