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Adoption Application - Other Pets

Please READ - Important Note:

To move from one box to the next, please either click on the next box or use the "Tab" key to move through this form. Do not use the "Enter" key, as this will submit the form before it is complete.

About the Applicant(Must be 18 years of age or older):
Applicant's name:
E-mail address (Please note that we primarily communicate by e-mail):
Home Phone Number (include area code):
Work Phone Number (include area code):
Cell Phone Number (include area code):
Address:
City:
State:
Zip Code:
Personal Information:
Why do you want a pet?
If there are children in the home, what are their ages?
What has your experience with pets been like in the past? Describe In Detail:
Is anyone in the house allergic to animals? YesNo
Does your entire household agree to this adoption? YesNo
What You're Looking For:
Pet Wanted: Guinea Pig Rabbit Llama Goat
Other
Age Desired: Baby (Weaned - 6 mo.) Young (6 mo. - 2 yrs) Adult (2 yrs +)
Sex MaleFemaleEither
Special Requests: (training, color, etc)
If pet is not altered, will it be done within 10 working days? YesNo
How long are you willing to give your new pet to adjust to it's new home?
Are you willing to give a home to an elderly pet, one with medical issues, or one that needs immediate training/obedience classes? Please be specific, because we have some wonderful pets needing new homes due to these very issues.
A pet with medical issues? YesNo
An older pet? Yes No
A pet with training issues? YesNo
Current Pet Living Situation:
Pet to live: Mostly IndoorOnly IndoorsMostly OutdoorEqual time In and Out
Describe outdoor shelter for pet:
Do you own other pets? YesNo
Number of cats or dogs: Cats: Dogs:
Are all dogs/cats altered? YesNo
If you have an unaltered pet, give your reason for doing so:
Do all current pets in your home have identification (microchipped, licensed, tags) in case they are lost? YesNo
Describe any other pets and livestock:
Are current pets up to date on vaccinations? YesNo
Current Vet: Name and Phone Number:
If no current vet, who you plan to use for your new pet? Name and Phone Number:
How long have you owned your current pets?
What has happened to pets owned in the past? (Be specific)
Do you rent or own? Rent ApartmentRent HouseOwn Home
Landlord's name and phone number, if applicable:
How long do you plan to live here?
Is your home located on: City LotCountry LotAcreage
Is your yard fully fenced? YesNo
Please provide information for three references (other than your vet or landlord) who know you as a pet owner or can vouch for your overall responsibility:
Reference #1 Name
Phone #
E-mail address
Relationship
Reference #2 Name
Phone #
E-mail address
Relationship
Reference #3 Name
Phone #
E-mail address
Relationship
Have you spoken to an SCC adoption counselor already? If so, please list their name:
Do any particular pets on the list interest you? YesNo
Please list their names and why they interest you:

By submitting this application, you agree that the addition of a family pet is an important decision. You have thought through possible changes that may occur in your life, and feel you would still be willing and able to care for this pet should they occur. You agree that if for any reason you can no longer care for this pet, you will without fail contact Second Chance Companions.

SCC makes random visits to adoptive homes to check on the well-being of the pet, and reserves the right to revoke the adoption if we find specific conditions are not being met. Terms will vary from pet to pet, and will be outlined on the adoption contract.
I HAVE READ AND AGREE WITH THE ABOVE STATEMENT.
YESNO

Upon receipt of this application, an Adoption Counselor will check your references, including your current vet, and then get back to you about scheduling a home visit. They will also tell you how to get in touch with the current caretakers of pets who would be a good match for your home. Your application will be processed as quickly as possible, but please understand we are staffed by volunteers and it may take a few days.

Second Chance Companions PO Box 2343 Battle Ground, WA 98604 Phone 360-687-4569 Email: info@sccpets.com
Updated Friday, May 13, 2005