JOHNSTON COUNTY SPCA ADOPTION APPLICATION
720 DURHAM ROAD
CLAYTON, NORTH CAROLINA 27520
(919) 553-3749
THANK YOU for your interest in one of our animals. By completing this questionnaire, you will enable us to help pick the very best animal for your situation. It is very important to us that the animals in our shelter find a compatible home. This questionnaire will help us to determine the personality, temperament, and energy level of the animal that would best suit your lifestyle. PLEASE READ THE QUESTIONS CAREFULLY AND ANSWER ALL QUESTIONS IN DETAIL. AN INCOMPLETE APPLICATION IS REASON FOR REFUSAL.
Date: Drivers License No.
Name: Spouse:
Address:
City: County: State: Zip:
Home Phone: Work Phone:
Employer and Address:
What animal are you applying to adopt?
Veterinarian(s) Name and Phone Number(s):
How did you hear about us?
Website Petfinder Friend Breeder Other-Please State
Please list 2 personal References with home telephone numbers. No more than one relative.
Please initial the following statement:
I understand that completing an application does not mean that I will be able to adopt an animal from Johnston County SPCA
Please answer the following questions:
1. Are members of the family home during the day? If yes, who?
2. List all people living in your home. Please include age and relationship:
3. Have you or anyone in your household ever been convicted of a felony? If yes, please explain:
4. Have you or anyone in your household ever been charged or convicted of animal cruelty, neglect or abuse?
5. Have you or anyone in your household ever surrendered any animals in lieu of prosecution?
6. Do you live in a house, condo, apartment, trailer, other?
7. Do you own, rent or other?
8. If you rent, does your rental agreement permit pets? How many? Any size limitations?
Please provide name and phone number of Landlord (and forward a copy of lease agreement)
9. If you own your home, any zoning or restrictive covenants on pet ownership (including number of pets allowed)? How long have you lived there? If less than 5 years, please provide previous address
10. Is property fenced? What type of fence?
Where will the animal you are applying to adopt be kept during the day (Inside, Outside, Dog house, shed, barn, kitchen, crate, etc.)? At night?
11. Describe any specific traits you are looking for in an adoptive animal:
12. Do you want to adopt a male or female? If you have a preference of the sex of the animal you wish to adopt, please explain your reasoning:
13. Age Preference (Please select any of the following that apply - Under 1, 2-3, 4-5, 6-7, 8-9, 10 or older):
14. How much do you think the annual maintenance of the animal you are applying for is? $
15. Do you have any pets currently? If yes, please list the Name, Age, Sex, Species and Breed:
16. Are your pets current on vaccinations? Rabies? Heartworm Preventative? Spayed? Neutered? If not spay or neuter, why?
17. Have you ever bred any of your pets? Raised a litter of puppies or kittens?
18. Have you placed, lost or euthanized any dogs in the past 2 years? If yes, please explain:
19. Have you ever applied to a Rescue, Shelter or Humane Society to adopt any animal? What were the results? What organization?
Please give directions to your home from a major highway:
Please read and sign below:
I have given true and accurate answers to the questions on this application and understand that any false information can void an adoption application. I agree to abide by the adoption guidelines set forth by the Johnston County SPCA and will notify the Johnston County SPCA if I move, cannot keep the animal or need to return it for any reason. I also understand that the Johnston County SPCA can take possession of the animal if conditions arise that will interfere with the humane treatment of the animal or it’s living quarters. I am over 21 years of age.
SIGNATURE: ____________________________________
DATE:____________
WITNESS: ______________________________________