Second Chance Salem Dog Rescue and Adoptions

Second Chance Salem Dog Rescue and Adoptions

Please complete your application fully and in as much detail as possible. This application is the first step in our adoption process. We will then screen your application through a vet reference check, phone interview, reference checks and a home visit. An adoption donation is required, which covers the cost of spay/neuter, microchipping, vaccines and preventatives per the dog's age, health check, fecal / deworming as needed. It is our goal to place all rescued dogs into loving, conscientious forever homes, keeping in mind the dogs’ individual needs and matching each dog’s personality to that of the home in which they are placed.
PROVIDING FALSE INFORMATION WILL RESULT IN THE FORFEITURE OF ADOPTION FEES AND ANY ANIMALS ADOPTED.
Dog's Name*
Your Name*
Address*
City*
State*
Zip Code*
Home Phone*
Cell Phone
Email Address*
How long have you lived at the above address?*
Do you rent or own?*
If you answered Other, please explain.
Your residence*
If you answered Other, please explain.
If you rent, does your lease allow pets?
If you answered yes, please note if there is a size restriction.
Please note if there are breed restrictions.
List the property management name & phone number below:
Your profession/employer*
Profession/employer of spouse/significant other*
Approximate monthly household income?*
Are you 21 years of age or older?*
Household member #1 - Name*
Please list all members of your household.
Household member #1 - Relationship*
Household member #1 - Age*
Household member #2 - Name
Household member #2 - Relationship
Household member #2 - Age
Household member #3 - Name
Household member #3 - Relationship
Household member #3 - Age
Additional household members*
Do you have regular visitors (animals/people)?*
If yes, whom?
Does any member of the household have allergies or asthma?*
If yes, please explain.
How many hours on average will your new pet be left alone on weekdays?*
How many hours on average will your new pet be left alone on weekends?*
How much do you plan on spending on this animal in a month?*
In a year?*
Please list all current and previous pets.
Pet #1 - Name*
Pet #1 - Age*
Pet #1 - Breed*
How long owned?*
Is the pet still with you?*
Type of pet*
Other:
Pet #2 - Name
Pet #2 - Age
Pet #2 - Breed
How long owned?
Is the pet still with you?
Type of pet
Other:
Pet #3 - Name
Pet #3 - Age
Pet #3 - Breed
Click to edit
How long owned?
Is the pet still with you?
Type of pet
Other:
Pet #4 - Name
Pet #4 - Age
Pet #4 - Breed
Click to edit
How long owned?
Is the pet still with you?
Type of pet
Other:
Additional pets
Have you ever had to give up one of your pets?*
If yes, please explain
Name / phone number of the veterinary clinic(s) for current / past pets:*
Name / phone number of the veterinary clinic(s) you plan to use for your new pet:*
Are/were your pets spayed or neutered?*
Are/were your pets on Flea/Tick prevention?*
Are/were your pets on Heartworm prevention?*
If yes, what type?*
How frequently do/did your pets go to the vet?*
How frequently do you plan to take your new pet to the vet?*
Please provide a brief medical history of any current or previous pets*
I am interested in adopting for*
Other:
I am interested in*
I am interested in a*
Please explain why*
Please explain why you want to adopt this particular pet*
Who will be responsible for feeding your pet?*
Who will be responsible for playtime/exercise?*
Who will be responsible for your pet's expenses?*
Where will your pet stay when you are out of the house?*
Where will your pet stay when you are home?*
Where will your pet stay overnight?*
Do you plan to crate your pet?*
How will you handle chewing, destruction or any other behavioral issues?*
We may require certain dogs to attend training classes. Is this acceptable?*
If no, please explain*
What do you plan to feed your pet?*
How often?*
Do you have a totally fenced-in yard?*
If yes, what height is the fence?*
Type of fence*
Are the gates kept locked?*
Can a stranger gain access to the yard?*
Do you own a pool?*
Is your pool fenced in?*
What do/will you do with your pets while you are on vacation?*
Are you planning to move in the near future?*
If you had to move, what would you do with your pet(s)?*
Please give names and phone numbers of two references.
Reference 1 - Name*
Reference 1 - Phone number*
Reference 2 - Name*
Reference 2 - Phone number*
Can an authorized representative of Second Chance Salem visit and inspect your home? *
How did you hear about our rescue?
I authorize a representative of Second Chance Salem to contact the veterinarian office named above to confirm the medical records/history of my pets. I understand that if I am unable to keep a pet adopted from Second Chance Salem, I will return the pet to Second Chance Salem. I understand that if I am unable to afford proper vet care for a pet adopted from SCS, I will contact SCS for guidance and assistance. *
Yes

Yes
No

No
Please Initial*
Should be Empty:

Second Chance Salem Dog Rescue and Adoptions

PROVIDING FALSE INFORMATION WILL RESULT IN THE FORFEITURE OF ADOPTION FEES AND ANY ANIMALS ADOPTED.

Please list all members of your household.

Please list all current and previous pets.

Please give names and phone numbers of two references.