Application Form

By Checking this box you agree to “NIAGARA SPCA AGREEMENT”

Niagara SPCA & Humane Society Dog Adoption Application

Dogs Name: *

Pet ID Number *

First Name *

Last Name *

Address *

City *

Postal code *

Phone *

Email *

1. Have you owned animals in the past 5 years? *

YES

YES
NO
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Type N/A if this question doesn't apply to you

2. Can we contact your veterinarian for past history? *

YES

YES
NO
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List is empty.

Type N/A if this question doesn't apply to you

3. Were your pet’s vaccines up to date including rabies? *

YES
NO
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4. If this was a dog, was it’s dog license updated yearly? *

YES
NO
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5. What do you plan to do with your pet if you move? *

6. What do you intend to do with your pet if you go on vacation, have an unscheduled trip or an emergency? *

7. How long have you been planning to adopt? *

8. Do you understand the responsibilities involved in owning a pet, for example: feeding, housing, medical care, yearly vaccinations, safety in and out of the home, by- laws relating to animals? *

YES
NO
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9. Are you adopting this animal for yourself? *

YES
NO
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10. If the answer to # 9 is ‘no’ please be advised that we do not adopt animals out for gift giving. *

11. Do the other members of your household know and approve of the adoption? *

YES
NO
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12. Do you have any objections to a property inspection? *

YES
NO
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13. Do you live in a: *

House
Apartment
Condo
Townhouse
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14. Do you rent or own? *

RENT
OWN
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15. If renting, please give landlords name and phone number. *

16. Check all that apply: *

Work outside home

Work at home

Student

Retired

17. Where will the pet be during the day? *

18. Where will the pet sleep at night? *

19. What is the maximum number of hours your pet will be left alone during the day? *

20. How many adults are in the home? *

21. Please list the ages of any children in the home: *

22. Please list any animal you own / have owned in the past 5 years (including any who has passed away) *

Name
Breed
Age
Sex
Fixed?
STill own? If Not, Why

23. Are your other animals’ spayed/neutered? *

YES
NO
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24. Will this animal be mainly kept *

INDOORS
OUTDOORS
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25. How many times a day will you exercise/walk your dog? *

26. How do you intend to housetrain your dog if it is not already done? *

27. How would you correct the following behaviors? *

Running Away:
Chewing:
Mouthing:
Barking:
Jumping:

28. Do you intend to take your dog to obedience/socialization classes? *

29. Do you have a fenced in yard? *

YES
NO
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30. Do you plan to tie or kennel your dog outside? YES or NO *

31. CURRENT VETERINARIAN *Type N/A if this question doesn't apply to you