ADOPTION APPLICATION

We will check Vet references, if there is not a valid reason for your animal(s) not
being current on vaccines, having been spayed or neutered and receiving yearly
checkups, your application will be ​automatically declined​. All questions must be
answered or application becomes ​invalid​. If you are interested in adopting a dog
over 30lbs, a dog considered by ACF to be a hunting/herding or extremely active
breed or a dog otherwise noted by ACF to need a fence; a fence will be ​required
in order to adopt.

Date: _____________

Animal Name: _______________ Breed:________________ Age:______ Sex:_______

Cash____ Ck____ Credit____ Fee_______

Name __________________________________________________________________________

Address_________________________________________________________________________

City______________________State_______________Zip________________

Driver’s License #:________________________________ Age_____________

Employer:___________________________________Occupation:____________________

Home Phone__________________________________

Cell Phone__________________________________

Email Address__________________________________

How long have you lived at this address? ____________ Do you _____own ______rent?

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What type of home do you live in- house, condo, apartment, mobile home, farm

If you rent, please provide the name and phone number of the landlord:

Name____________________________________Phone #___________________________

1. How many adults and children living in the home? Age of children? _______________

2. Is everyone in the home in agreement with the decision to adopt a dog/cat? _______________

3. Do you have time to provide adequate love and attention? ______________

4. Please list the pets you own:

NAME BREED/DOG OR CAT AGE/SEX SPAYED/NEUTERED

5. Are these pets current on vaccines? _______________

6. Have you ever surrendered a pet?

If so, why?_________________________________________________________

___________________________________________________________________

7. How do you discipline your pets? __________________________________

8. Where will the dog/cat spend the day? __________________________________

9. Where will the dog/cat spend the night? __________________________________

10. List the number of hours on average that the dog/cat will spend alone per day. _______
Will you be able to exercise your dog/cat appropriately?_________________________________

11. Who will have primary/financial responsibility for this dog’s/cat’s daily care?
__________________________________

12. Do you agree to provide regular health care by a licensed Veterinarian?______

13. All animals adopted shall be spayed/neutered by 6 months of age. (Initial) ___________
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14. Do you agree to provide a ​fenced in area​ for your dog when it is outdoors? ​If no fence​, what
other type of containment will you use?
_________________________________________________________________________________

15. Do you agree to keep your cat as an indoor pet? ___________

16. You agree to contact the Animal C.A.R.E. Foundation if you can no longer keep this dog/cat?
(Please initial) ______________

17. ACF reserves the right to withdraw this animal from your home if we determine its needs are not
being met adequately. (Please initial) __________

18. Do you have a regular veterinarian? ____Yes ____No (if no, list who you plan to use)

***​IS THE ACCOUNT UNDER YOUR NAME AT THE VETERINARIANS OFFICE​***

***Vets Name:___________________________________________________

Address:__________________________________________________________

City:___________________State:______________Zip:__________________

Phone number:_________________________________________________________

*​PLEASE LIST ANY CLINIC YOU HAVE TAKEN YOUR PET TO OTHER
THAN YOUR REGULAR VET FOR VACCINES AND OR SPAY/NEUTER

Name of Clinic_____________________________________ Date:________________________

Phone number:_________________________________________

***Please list a non-relative who is familiar with you and your pets.

Name:_____________________________________________________________

Address:___________________________________________________________

City:______________________State:_________________Zip:_______________

Phone number:_____________________________________________________

Relationship to you:_________________________________________________

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A representative will call in one week for follow-up and make a home visit if needed, prior to
and/or following this adoption.

$150.00 adoption fee for dog/puppy includes up to date vaccines and spay/neuter. If your
puppy is not spay/neutered at time of adoption he/she is covered in full when using ACF’s
spay/neuter transport, Humane Society of the Piedmont, Sheets Pet Clinic or a Vet of ACF’s
choosing. If you choose to have this puppy spay/neutered at a vet of your choice, ACF will
only cover $80 towards the spay/neuter of this animal.

$80 adoption fee for cats, $60 adoption fee for kittens includes up to date vaccines and
spay/neuter. If your kitten is not spay/neutered at time of adoption he/she is covered in full
when using ACF’s spay/neuter transport, Humane Society of the Piedmont, Sheets Pet Clinic
or a Vet of ACF’s choosing. If you choose to have this kitten spay/neutered at a vet of your
choice, ACF will only cover $60 towards the spay/neuter of this animal.

This dog/cat will reside in my home as a pet. I will provide it with food, fresh water, shelter,
affection, annual physical examination and vaccinations under the supervision of a licensed
Veterinarian.
I agree to hold the Animal C.A.R.E. Foundation harmless to the risk of being bitten, scratched,
or injured and to any damages to my property by this adopted animal. All of the information I
have given is true and complete.

_________________________________________________________________________________
SIGNATURE DATE

Revised 2/14/17

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 SPAY/NEUTER AGREEMENT

I ______________________, agree to have puppy/kitten spayed or neutered

by the date that the Foster Care/Adoption Coordinator of the Animal C.A.R.E.
Foundation designates.

The Foster Care/Adoption Coordinator will call and arrange for your pet to be
spay/neutered at the vet/clinic of our choosing (this spay/neuter is covered by
the adoption fee) on a date before the animal reaches 6 months of age.

By signing this, you are acknowledging that you are to have this puppy/kitten
spayed or neutered on the date determined by the Animal C.A.R.E.
Foundation. Failure to do so will result in the reclaiming of the adopted animal
by ACF.

_____________________________ ___________________________
Adopter Signature Date

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