NYS RR076
First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Home Phone
Cell Phone*
Alt Email
Which Dog/Puppy are you interested in? *
Are you 18 years of age or older?* Choose one: Yes No
Are you or your spouse/co-applicant employed?
Employer:*
Please list current veterinarian
Current veterinarian phone number
Please list a reference - only 1 being a family member (Name, Phone, Relationship):*
Please list a reference - only 1 being a family member (name, phone, relationship):*
Do you rent or own your home?* Choose one: Rent Own
How long have you lived in your home?*
If you rent do you have your landlord's permission?
Landlord's Name
Landlord's Phone
Is your home a:
Do you plan to move anytime soon? If yes, when and where?*
Please list all other pets (cat/dog/other species) living in your home and if they are spayed/neutered:*
How long will your new pet be alone each day?*
How do you plan to keep your pet on your property when they are outside? (fence, run, leash, etc.) *
Please describe your lifestyle and energy level?. (do you walk/run or hike? Do you skip walks on some days.)*
How will you discipline your pet for misbehavior. (ex. chewing, accident in house, running away, etc.)*
Please list anyone living in your home, their relationship to you and their age (including yourself)*
If there aren’t any children in your home, are there children who visit regularly? If yes, please list age and relationship.*
Does anyone in your home have allergies?* Choose one: Yes No
Have you previously had pets? (Please list pet's name, species, breed, age, and what happened to your pet.) *
If you had to give up a pet, please detail why.*
Why are you looking for a new pet?*
What characteristics are you looking for in a pet? (Energy level: low, medium, high, playful, lazy)*
Why would you make a great home for this pet?*
What do you think it will cost per year to care for this pet? Please list anticipated expenses.*
How often do you think your pet will need to see a veterinarian? Please detail.*
What amount of time do you consider reasonable for your new pet to adjust to life in your home?*
If your pet has or develops behavior issues (urinating, chewing, scratching, digging, excessive barking, etc...), how will you handle the issue?*
Please elaborate on individual circumstances you feel may affect your ability to care for your pet. If something life changing should happen to you making the pet an obstacle or inconvenience to you (i.e. move, divorce, kids leave home, lose job, illness, having children, etc.) what would you do?*
What circumstances might cause you to return this pet to us? *
The average life expectancy of a dog is 10-17 years. Are you prepared to care for this pet for its entire life?
Who will be primarily responsible for the care of this pet?*
IMPORTANT: * You understand that if this adoption doesn’t work out, you MUST return the pet to the Wyoming County SPCA. * Your signature also indicates that you fully understand the previous questions and you have answered them honestly. * You understand that Wyoming County SPCA reserves the right to refuse any applicant, for any reason. * If a home visit is not possible, please be prepared to share pictures of your current dogs and their living arrangements. * Applications are NOT “first-come-first-served”. Adoptions are based on the best home for each pet and the best pet for your household. *Applications take time to process. By submitting this application, you are indicating to the Wyoming County SPCA that you are serious about adopting a pet from us. If you change your mind after you have been approved for a reason that has nothing to do with us or the dogs we ask for a $25 donation for consideration. If you do not hear from us within 3 BUSINESS days (M-F) of sending your application, please email info@wyomingcountyspca.com to be sure we received it. Please contact your veterinarian office and give permission for us to obtain information.