All applications are reviewed by our adoption committee. Please print and complete this form then scan and email to Claiborneshelter@yahoo.com OR fax to 423-626-2686
All of our animals are spayed or neutered and micro-chipped prior to going home. It's included in the adoption fee!
Note: False information on this application could result in the forfeiture of adoption fee and animal adopted. We reserve the right to refuse any applicant.
Animals Name____________ Approx. Age _________ Dog ____ Cat ____ (check one)
Street Address: ____________________________________________ Apt: _________
City: __________________________________ State:_______ Zip Code:_________
Home Phone: ______________________ Work Phone: _____________________
Cell Phone: ________________________ E-Mail: _________________________
Describe Your Residence: _____Single Family Home ____Apartment ____ Dorm
____ Condo _____ Multi-Family Home ____Mobile Home
Ownership of Residence: ________ I Own _______ I Rent
If You Rent: Landlord’s Name and Phone Number: (REQUIRED) _______________________________________________________________________
Do all the adults that live in your home agree with this pet adoption? ___Yes __No
Number of Adults in your home: _______ Number of Children_______
Please list the children’s ages: ____________________________________________
Are you currently expecting a child? ________Planning for a child? __________
If you or your spouse becomes pregnant, what will you do about your pet(s)? _________________________________________________________________________
Does anyone in your household have pet allergies? ___ Yes ____No
How many hours a day will your pet be left alone? _______________________________
Do you have a fenced yard? __________ Approx. Size of Fenced Area _______________
Where will your pet stay if you are out of town? _________________________________
Would you allow Claiborne County Animal Shelter visit your home? ___Yes ___No
If No, why not? ___________________________________________________________
If you currently own pet(s), please list type, breed, and age of each ___________________
Where are these pets now? (Still with you, died of natural causes, put to sleep, sold, ran away, given away, etc.) ___________________
Are all your current pets (if any) spayed/neutered? If not, why? ___________________
Are your current pet’s (if any) vaccinations up to date? ___________________
Do you know how to protect your dog from heartworms? ___________________
Who is your veterinarian? ___________________________________________________
When was your last visit? ___________________ What is your vet’s phone number?________________
How much are planning to budget per year for pet care? ___________________
Where will this dog sleep? ___________________
Do you have a swimming pool? ___________________
Have you ever had a pet that was struck and/or killed by a vehicle? ___________________
What plans do you have for obedience training? (classes, video, books, in-home lessons, none, other) ___________________
Have you ever had a serious behavioral problem with a pet? If yes, please explain____________.
How will you resolve behavior problems that may appear with this dog? ____________.
If necessary, what procedures will you use for housebreaking this dog? (crate training, newspaper, rubbing nose, swatting with newspaper, outside only, other) ____________.
I certify that I am at least 18 years old and that the information I have given above is true I am aware that I am adopting a living creature and, as such, that CCAS cannot guarantee the health of the animal. I also understand that the age of the animal is an estimate determined by the staff of CCAS, and by signing below, I understand that I am not entitled to a discount or refund should an age discrepancy be determined by my veterinarian.
Adopter’s Name Date