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Shoals Animal Advocates2701 Mall Drive, Suite 7, PMB 276 Florence, AL 35630FAX 256-766-7845Stephanie (256) 415-7155 Cheryl (256) 653-7561 or 256-651-8846

Adoption ApplicationIn order to make a perfect match for you with one of our adoptable pets, we need to know as much about

you as a pet owner as possible. Please fill out this application completely and honestly.

Which animal are you interested in adopting? ___________________________________________________

Your Information

Name: _____________________________________Main contact #: __________________________________

Second contact #: ________________________ Email address: ______________________________________

Physical Street Address: ______________________________ City, State, Zip: ___________________________

Employer: ___________________________________ Work #: _______________________________________

Spouses/Partners name and contact #: _________________________ ________________________________

Number and ages of children: _________________________________________________________________

Have you carefully considered the financial cost of animal ownership and are you financially able to give youranimal the routine medical care it requires? Yes No

Do you currently have pets? Yes No Type/breed/age (s)? _______________________________________

Are they spayed/neutered? Yes No Are they up to date on all vaccinations? Yes No

If not, why not? ____________________________________________________________________________

Will you keep your pet on a heart worm preventative? Yes No

What happened to the pets you no longer own? __________________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________

Does everyone in the family agree about adopting the animal? Yes No

Who will be the primary caregiver and trainer of the animal? _______________________________________

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Does anyone in the household have allergies to animals and if so, what? Yes No _______________________Why do you want to adopt this particular pet? Companion Watchdog Companion for another petMouser Hunting Other-explain_______________________________________________________

Environment InformationDo you rent or own? ___________ If you rent, can you furnish a notarized letter from your landlord grantingyou permission to have an animal on the property? Yes No

Is your yard fenced? Yes No If not, will the animal be supervised at all times when outside? Yes No

Where will your new pet be kept during the day? In House-Kennel or Crate Fenced Yard Tie-Out ChainGarage Patio Area Outside Dog Run BasementOther, please explain _______________________________________________________________________

Will there be anyone home during work hours? Yes No If not, how many hours per day will the animal beleft alone? ______________ Where will the animal spend its time alone? ___________________________

Do you travel frequently? Yes No Will the animal travel with you? Yes No

If not, where will the animal stay while you are gone? _____________________________________________

If you move, what will you do with your pet? _____________________________________________________

Veterinarian Information

Please provide the information for the veterinarian you plan to use for this animal.

Name: ______________________________________ Phone: _______________________________________

Address: ____________________________________ City/State/Zip Code: _____________________________

Have you used this vet in the past? Yes No If not, please provide information for a past vet you have used.

Name: ______________________________________ Phone: _______________________________________

Address: ____________________________________ City/State/Zip Code: _____________________________

ReferencesPlease provide the name, address, and phone number for at least 3 people (not related to you) who wouldrecommend you as a good adoptive family for a rescued animal. Use the back of the page if you need moreroom.

1. ________________________________________________________________________________ 2.

________________________________________________________________________________

3. ________________________________________________________________________________ Do

you agree that the animal will be returned to SAA if for any reason you are unable to keep it? Yes No

You will be asked to sign a legally binding contract returning this animal to SAA if you are unable to keep himor her at any point in their l ifetime.

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I certify that the information provided on this form is true and correct. I am also financially and physically ableto care for this animal. I understand that proper food and veterinarian care can be costly and I am able tomeet these requirements.

All applicants are subject to a home visit. Home visits are made on a random basis following or prior toadoption. If upon inspection, Shoals Animal Advocates (SAA) finds information contained in this application to

be false, SAA retains the right to turn down the adoption or remove the animal from your premises without arefund of moneys paid. SAA reserves the right to refuse or reject an application for whatever reason it deemsfit.

Applicants Signature______________________________________ Date ________________

SAA Representative _______________________________________ Date ________________