Cumberland County SPCA & Animal Shelter

Name(s):       Co-Adopter:   

Address:   

City:      County:  State:     Zip:  

Phone: (Home)                                         (Work)                      (ext.)                                    (Cell)
                                                   
Email address:      Social Security Number: 

How long have you lived at this address?   
 
If less than 6 months, please list previous address and landlord:   
Address: 

City: State: Zip: 

Landlords Name(s): 



Are you planning on moving in the next 6 months?       Yes No

Do you live in a:    House Apartment Moblie Home Condo Dormitory

Do you own or rent?    Own Rent

If you rent, please list your landlord's name and phone number.    

Have you adopted from this S.P.C.A before?    Yes No

If you've adopted from us in the past, how long ago was it?   

Please list your place of employment and the phone number: 

Phone number in case of an emergency: 

Reference 1:

Reference 2:

Reference 3:


What hours are you usually at home? 

Ages of any children living in your home: 

Can we visit your home?    Yes No

Where will your pet spend most of it's time?    Outside Inside

If outside, how will your pet recieve exercise?    Walks Chain Dog Run Fenced Yard

If outside, what type of pet housing do you have?  

Will this be your first pet?   Yes No

What type of pets did you previously own?   Cats Dogs Both

How many dogs do you have now, and what are their names? 

How many cats do you have now, and what are their names? 

Do you have any pets other than cats and dogs? If so, what? 

If you do not currently have pets, how long has it been since you last had a pet? 

If you have Animals now, are they spayed or neutered?   Yes No

Where do your current pets spend most of their time?   Inside Outside

Please state your veterinarians name: 

Please state your veterinarians phone number (include area code please): 

Will you agree to have the new pet spayed/neutered?   Yes No

Do you have an area where the new pet can be isolated for housebreaking puproses?  Yes No

Are you aware that the basic annual veterinary care your pet will need to assure him/her a healthy, happy life on 10-20 years?            Yes    No

Are you aware that the annual cost of owning a pet will be $300-$600 with proper food and vet care? 

Yes No

WHAT ARE YOUR REASONS FOR ADOPTING A PET ?
House pet/companionGuard Dog/insideGuard Dog/outsideHuntingBreeding
Barn CatFor the childrenGift for someoneWant to save