SNIPSA Adoption Application

Adoption Application
GENERAL INFORMATION

Thank you for your interest in the adoption of an animal from SNIPSA, Inc. We would appreciate you answering the following questions so that we can best determine compatibility between you and the animal in question.

Adoption Fees
Dogs/Puppies: $250 - $350
Cat/Kittens: $150

Our adoption fee includes spay/neuter, microchipping, heartworm testing (treatment if necessary), FIV/FeLV test, age appropriate vaccinations, fecal float, treatment for internal/external parasites, and a complete veterinary physical exam.

ALL QUESTIONS ON THE APPLICATION MUST BE ANSWERED IN ORDER FOR YOUR APPLICATION TO BE CONSIDERED. IF A QUESTION IS NOT APPLICABLE, PLEASE MARK AS SUCH.

Thank you for your help and cooperation.
IN ORDER TO BE CONSIDERED AS AN ADOPTER, YOU MUST MEET ALL OF THE FOLLOWING CRITERIA:

1. Be 21 years of age or older
2. Have the knowledge and consent of all adults living in your household
3. All pets currently residing in the household must be spayed or neutered
4. Understand that SNIPSA, Inc. reserves the right to refuse an applicant
ANIMAL INFORMATION

*denotes required
Name of Animal *
Date *

Month Day Year
Would you be willing to accept and care for an animal with special needs (abused, needs medical attention, behavioral problems, etc.)? *

Yes No
PERSONAL INFORMATION

*denotes required
Name *

First Name Last Name
Name of spouse or other adult living in home. *

First Name Last Name
*Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
County *
*Home Phone *

Area Code Phone Number
Cell Phone

Area Code Phone Number
Email *
Occupation *
Place of Employment *
Spouse or other adult's occupation *
Age *
Any children living in the home. *

Yes No
Chidren's Ages (please separate ages with a comma) *
Do you consider yourself financially stable enough to provide proper diet and medical care for an animal, including emergency treatment if needed? *

Yes No
What do you consider a reasonable amount to spend annually for this animal? *
How long have you been looking for a new animal? *
HOUSEHOLD INFORMATION

*denotes required
Do you *

Rent Own
Where do you live? *

House Apartment Condo/Townhome Trailer Other
*If you rent, Landlord/Property Manager Name *
*Landlord/Manager Phone (If you own your own home, please put your own phone number) *

Area Code Phone Number
Which best describes your fence *

No fence 3 feet 4-5 feet 6 feet or over N/A - I'm interested in a cat
What type of fence do you have? *

Wood Chain Link Other No Fence N/A - I'm interested in a cat
How long have you lived at this address? *
Does everyone in the house know and approve of this animal? *

Yes No
Is anyone in the house allergic to dogs/cats? *

Yes No
If yes, who?
Do you own livestock? If so, what type? *
Do you travel frequently? *

Yes No
If yes, how often and who will care for the animal?
PET CARE INFORMATION/PET EXPERIENCE

*denotes required
In the event that you or your family can no longer care for your animal(s), due to unforeseen reasons:(death, hospitalization, funds, retirement facility, illness, rest home, etc.), what provisions have you taken to insure care and safety for the animal(s)? *
Do you own other cats or dogs? *

Yes No
How many?
Please list name, breed, sex and age of each dog or cat that you own
Are all your animals spayed or neutered? *

Yes No N/A
If no, which animal and why is he/she not altered?
If you have had a dog/cat before, please describe the last dog/cat you owned and what happened to it.
Have you ever had to give up your pet? *

Yes No
If yes, why?
Why are you interested in rescuing an animal? *
How many hours a day will this animal spend alone at home? *
Where will the animal be kept during the day? *
At night *
Are you willing to buy a crate? *

Yes No Already have one
Are you willing to take this dog to obedience class? *

Yes No N/A - I'm adopting a cat
How will you exercise the dog? If interested in a cat, please check last box. (Check all that apply) *

Leash walks Dog park Let run in fenced area Let run in unfenced area Dog run Let run in unfenced area Cable run in yard Other N/A I'm interested a cat
Do you understand that the animal you want to adopt is a RESCUED ANIMAL, and may experience behavioral/medical issues such as , but no limited to: separation anxiety, fence jumping, housetraining, chewing, digging, etc. *

Yes No
Do you understand that in adopting this pet, you are not adopting a PERFECT animal? Rather you are investing in a rescue because you believe in our life saving mission? *

Yes No
Are you committed to caring for this animal for his/her LIFETIME? *

Yes No
What are you going to do if your puppy gets larger than expected? Skip if you are interested in a cat.
What do you consider unacceptable behavior? What circumstances would prevent you from keeping this animal for his/her lifetime? *
Are your current animals up to date on: (check all that apply) *

Yearly Exam Yearly Heartworm Test (Dog) FeLF/FIV Test (Cat) Vaccinations Monthly Flea Prevention Monthly Heartworm Prevention N/A
Name of heartworm and flea medicine your dog is on currently.
VETERINARIAN INFORMATION

If you presently own an animal, please list the veterinarian clinic(s) and veterinarian(s) treating your animal. If you have lost a pet recently, please list the veterinarian that was caring for your animal.
Name of veterinary clinic(s):
Name of veterinarian(s):
Clinic Phone Number

Area Code Phone Number
Additional Clinic Phone Number If Multiple Clinics Visited

Area Code Phone Number
REFERENCE

Please do not use family member or person living with you.
Name *

First Name Last Name
Phone Number *

Area Code Phone Number
Email *
How did you find the dog you are interested in adopting? *

SNIPSA Website Petfinder.com Adopt-a-pet.com Facebook/Twitter Posting Flyer in store Met at an event Referred by friend Other
Transportation - We do not have a transport company. If you are adopting from out of state, you would be responsible for transportation arrangements and any fees incurred - we will help facilitate in any way we can. If applicable, do you have arrangements for transport?
*For the health of our pets, we reserve the right to adopt to smoke-free homes only. We appreciate your understanding.
AGREEMENT
I hereby affirm that I have answered the about information truthfully and to the best of my knowledge. I give my permission for SNIPSA, Inc. to contact the landlord, veterinarian, and personal references I have provided, and I give my permission for these references to release any information relevant to the adoption of this animal to SNIPSA, Inc.
Signature *

Clear
Date *

Month Day Year
Yes! Please sign me up to receive text messages from SNIPSA. Normal text messaging rates apply. Receive up to 4 messages per month.

Sign me up!
Yes! I would like to be contacted via email or text for SNIPSA fundraising events! *

Yes No
When do you plan on taking your new pet home?
Should be Empty:

Adoption Application

ANIMAL INFORMATION

PERSONAL INFORMATION

HOUSEHOLD INFORMATION

PET CARE INFORMATION/PET EXPERIENCE

VETERINARIAN INFORMATION

REFERENCE

AGREEMENT