Adoption Interest Form

To be considered as an adopter, you must:

Be 18 years or older.
Understand that submitting an interest form means you must go through the approval process.
Have the knowledge and consent of your landlord (if renting).
Allow GCSPCA to contact both vet and personal references (if applicable). All current pets must be current on Rabies.
Consent to a home visit by a GCSPCA representative (if applicable).
Be able and willing to spend the time and money necessary to provide training, medical treatment (including monthly Heartworm preventative), and proper care for an animal.

Completion of this interest form does not guarantee adoption of a GCSPCA animal. We reserve the right to refuse an adoption for any reason.

Contact Information

First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
-

Email*

Cell Phone*

*=required

Tells us more...

NAME of animal interested in adopting? If you're submitting an interest form solely for pre-approval, please choose "pre-approval dog" *

Name of additional animal interested in adopting? (optional)

Is this animal for? (check all that apply)

Yourself	Spouse/Partner
Child(ren)	Family pet
Protection/guard dog	Companion for another pet
Gift	Other

If other, please specify

Is this your first pet?*

Yes

Your Age*

Your Employment Status*

Full-time	Part-time
Unemployed	Student
Retired

Household Information

Number of Adults (including self and roommates)*

Number of Children*

Ages of Children

Do you or others have allergies specific to animals?*

Yes

Type of Residence*

Single Family	Duplex
Apartment	Townhouse
Condo	Other

Do you own or rent?*

Own	Rent
Live with Parents	Other

How long have you owned/rented?*

Landlord/Manager Name

Landlord/Manager Phone

Is there pet weight or breed restrictions?*

Yes

If yes, please specify

Do you have a fenced yard or area?*

Yes

If yes, please specify fence height and type (wood privacy, chain link, invisible, etc.)

Pet Information
Please list all animals currently residing in your home (including roommate’s) & for the last 5 years; if more than 4 animals in the home please use the comment section to list additional animals)

Pet #1 - Pet Name and Breed or Type (dog, cat, etc.)

Pet #1 - Age

Pet #1 - Sex

Male

Female

Pet #1 - Spayed/Neutered

Yes

Pet #1 - Time Owned

Pet #1 - Where is the pet now?

Pet #2 - Pet Name and Breed or Type (dog, cat, etc.)

Pet #2 - Age

Pet #2 - Sex

Male

Female

Pet #2 - Spayed/Neutered

Yes

Pet #2 - Time Owned

Pet #2 - Where is the pet now?

Pet #3 - Pet Name and Breed or Type (dog, cat, etc.)

Pet #3 - Age

Pet #3 - Sex

Male

Female

Pet #3 - Spayed/Neutered

Yes

Pet #3 - Time Owned

Pet #3 - Where is the pet now?

Pet #4 - Pet Name and Breed or Type (dog, cat, etc.)

Pet #4 - Age

Pet #4 - Sex

Male

Female

Pet #4 - Spayed/Neutered

Yes

Pet #4 - Time Owned

Pet #4 - Where is the pet now?

Have you ever rehomed a pet?*

Yes

If yes, please explain

Have you ever euthanized a pet?*

Yes

If yes, please explain

Veterinarian Information
**Please notify your vet of your permission for our volunteers to discuss your pets’ vet records.

Vet Name*

Vet Phone

What type of heartworm preventative do you use?*

General Environment

How many hours per day will the animal be alone?*

Where will the animal stay when alone?*

Where will the animal sleep at night?*

Who will care for the animal when you go out of town?*

Future Plans

Under what circumstances would you return the dog to us? (check all that apply)

Aggressive behavior	Behavioral problems
Child(ren) lost interest	Doesn't get along with other animals
Housebreaking issues	Married/Divorced
Medical issues	Move
New baby	New job
Too time-consuming	None of the above
Other

If other, please specify

Are you willing and able to pay the veterinary costs of caring for your new animal?*

Yes

Are you willing to take the time to work with the animal on behavioral issues (housebreaking, chewing, etc.) if such problems arise?*

Yes

Personal Reference

Reference Name*

Reference Relationship*

Reference Phone*

Best time to contact*

Comments

Additional Comments or Information

*=required