APPLICATIONS | animalshelter

PRINTABLE ADOPTION APPLICATION

Dog License

Online Form

I'm looking to:

Full name & name of spouse/partner:

What year were you born?:

Preferred phone:

Alternate phone:

May we email you?:

Complete address (Include: house/apt #, street, city & zip)

About your home:

Name & phone number of homeowner/property management (if not you):

How long have you lived there?:

Any plans to move?

What are you looking to adopt?:

What age range do you prefer?:

Name of pet you are applying for (if you have someone specific in mind):

Tell us more about your ideal pet so we can better match you with the right fit (dog/cat/kid friendly, age, size, breed, etc.):

If you go away, who will take care of your pet?:

If you have to move & your pet cannot come, or you become incapable of providing care, what plans do you have for pet?:

How long have you been thinking about adopting AND why is now the right time?:

Is this pet a surprise for someone? Who?:

Everyone in the home has been exposed to adult cats/dogs and have been found to:

How many adults AND children live in the home & what relation are they to you? Include ages of the children:

What reason(s) can you think of that would lead to you giving up a pet?

If a pet started to urinate/defecate inappropriately, what would you do?

Provide: 1) Occupation 2) Employer 3) How long you've been w/this employer:

This pet will be:

Have you owned pets before?:

Veterinarian: Give the name AND number of the veterinary practice(s) that you have used. CALL THEM TO GIVE PERMISSION TO SPEAK WITH US, please. (If you have not had a vet in the past, provide the name and number for the practice you plan to use.):

Tell us about your most recent pets (past or current): Name of pet #1:

Species:

Sex/Gender

Breed AND Age

Pet Status

Date of last vet visit:

Name of pet #2:

Species:

Sex/Gender

Breed AND Age

Pet Status

Date of last vet visit:

Name of pet #3:

Species:

Sex/Gender

Breed AND Age

Pet Status

Date of last vet visit:

Comments or notes for application reviewer:

List THREE references (they must know you well & be able to communicate with us). Provide: 1) Name 2) Phone number 3) How they know you. PLEASE LET THEM KNOW THAT THEY SHOULD EXPECT A CALL.

By checking this field, I agree that I am executing this document with full understanding that filing a false statement may result in disapproval of animal adoption and/or appropriate legal action being brought by the Town of Smithtown. I personally read and provided answers to each and every question herein and I attest that each and every answer is full, true and correct in every respect.

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TOWN OF SMITHTOWN ANIMAL SHELTER

ADOPTION CENTER & ANIMAL CONTROL

Online Form