Shoals Animal Advocates

2701 Mall Drive, Suite 7, PMB 276 Florence, AL 35630

FAX 256-766-7845
Stephanie (256) 415-7155 Cheryl (256) 653-7561 or 256-651-8846

Adoption Application
In 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 your
animal the routine medical care it requires? Yes No
Do you currently have pets? Yes

No

Are they spayed/neutered? Yes No

Type/breed/age (s)? _______________________________________

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? _______________________________________

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 pet
Mouser
Hunting
Other-explain_______________________________________________________

Environment Information
Do you rent or own? ___________ If you rent, can you furnish a notarized letter from your landlord granting
you 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 Chain
Garage
Patio Area
Outside Dog Run
Basement
Other, please explain _______________________________________________________________________
Will there be anyone home during work hours? Yes No If not, how many hours per day will the animal be
left 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: _____________________________

References
Please provide the name, address, and phone number for at least 3 people (not related to you) who would
recommend you as a good adoptive family for a rescued animal. Use the back of the page if you need more
room.
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 him
or her at any point in their lifetime.

I certify that the information provided on this form is true and correct. I am also financially and physically able
to care for this animal. I understand that proper food and veterinarian care can be costly and I am able to
meet these requirements.
All applicants are subject to a home visit. Home visits are made on a random basis following or prior to
adoption. 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 a
refund of moneys paid. SAA reserves the right to refuse or reject an application for whatever reason it deems
fit.

Applicants Signature______________________________________ Date ________________

SAA Representative _______________________________________ Date ________________