The SPCA of Pittsylvania County

First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone

Work Phone
x

Cell Phone

Which particular pet are you interested in?*

How did you hear about us?*

Why are you interested in adopting a pet at this time?*

What type of pet are you looking for? Housedog/Companion/Guard Dog/Working or Hunting Dog/Gift/Other*

What attracted you to this pet?

What traits are you looking for in a pet?

How much time will the pet spend alone during the day?*

Where will the pet be kept when you are home?*

Will the pet be kept inside or outside?*
Choose one: Inside Only Outside Only Inside and Outside

Where will the pet sleep?*

Where will the pet be kept when you are not home?*

Have you ever given up a pet? If yes, please explain.*

Do you own or rent your home*
Choose one: Rent Own

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

If you rent, have you received the approval of your landlord to have an animal*
Choose one: Yes No Not Applicable

How many people reside in your household*

What are the occupation(s) of the adults in the home?

Is anyone in the home allergic to animals?*
Choose one: Yes No Not Applicable

Who in the household will care for the pet*

Please describe how you will train the pet.*

A dog or cat may live 15 years or more. Do you agree that pet guardianship is a lifetime commitment?*
Choose one: Yes No Not Applicable

Veterinary costs and medications can be several hundred dollars per visit. Are you financially able to take care of this pet?*
Choose one: Yes No Not Applicable

Are your current pets up-to-date on their vaccinations?*
Choose one: Yes No Not Applicable

Are your current pets already spayed or neutered?*
Choose one: Yes No Not Applicable

For cats only: Are you planning to declaw?*
Choose one: Yes No Not Applicable

Under what circumstances would you be unable to keep this pet?*

What type of punishment would you use if the pet became destructive or misbehaves?*

What will happen to the pet if you unexpectedly move?*

Where would the pet be kept when you travel?*

Is your yard fenced?*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

If you do not have a fence, will you be willing and able to construct a fence if your pet requires it?
Choose one: Yes No

What is the height of the fence?*

Do you own any pets at the present time?*
Choose one: Yes No Not Applicable

Veterinarian's Name and Phone Number*

Please list two personal references with address and phone number.*

Would you object to an inspection of your premises by our staff?*
Choose one: Yes No Not Applicable

I certify that the information entered on this applicant is true. Enter your name and date.*