APPLICATIONS | animalshelter

Online Form

Adoption Application

Full Name & Name of Spouse/Partner

Phone Number(s) - Preferred number 1st, then alternate

FULL ADDRESS: 1) House Number 2) Street 3) Apt 4) City 5) State 6) Zip

How long have you lived there?

Name AND phone number of homeowner (if not you)

What year were you born?

Name of pet you are applying for:

Tell us more about your ideal pet (dog/cat/kid friendly, breed, size, etc)

If you have to move & your pet cannot come, what plans do you have for pet care?

How long have you been thinking about adopting AND why is now the right time?

Who will care for the pet if you go away?

Is this pet a surprise for someone? Who?

How many adults live in the home, what relation to you?

How many children live w/you & what are their ages?

What reasons would lead to you giving up a pet?

If a pet started to urinate/defecate inappropriately, what would you do?

Provide: 1)Occupation 2) Name of employer 3)How long you've been w/this employer

Provide name(s) AND phone number(s) for the vet practice(s) you have used. CALL THEM TO GIVE PERMISSION TO SPEAK W/ US

Pet #1: Name

Breed & age of pet

Date of last vet visit?

Pet #2: Name

Pet #3: Name

Breed & age of pet

Date of last vet visit?

Breed & age of pet

Date of last vet visit?

Comments or notes for application reviewer:

List THREE references (they must know you well AND speak English): 1) Name 2) Phone number 3) Relationship to you

By checking this field, I agree that I am executing this document with full understanding that filing a false statement may result in disapproval of animal adoption and/or appropriate legal action being brought by the Town of Smithtown. I personally read and provided answers to each and every question herein and I attest that each and every answer is full, true and correct in every respect.

Your Signature

Thanks for submitting!

TOWN OF SMITHTOWN ANIMAL SHELTER

ADOPTION CENTER & ANIMAL CONTROL

Online Form

Adoption Application