| Name:
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| Home
Phone: |
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| Work
Phone: |
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| Physical Address:
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| City: |
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| State: |
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| Zip: |
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| (RQUIRED) Email: |
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| Describe the "ideal" cat(s) or dog(s) for your family. What are you looking for in a pet? |
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| Name
of cat(s) or dog(s) you are interested in: |
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| Why
do you want to bring a new pet into your home? |
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| What
do you think are the most important responsibilities in owning
a pet? |
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| For
whom are you adopting the pet? |
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| What are your feelings regarding pets on furniture? |
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| What are your feelings regarding shedding? |
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| Haw many hours would this new pet be left alone in a typical day? |
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| Do you work outside the home? |
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Yes
No |
| Are you willing to allow a new pet time to adapt to its new environment and family? |
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Yes
No |
| How long of an adjustment period would you consider to be acceptable for a new pet to adapt? |
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| Some rescued pets might have training issues that might be known prior to adopting or might arise after an adoption. We list all issues we know of in the pet’s bio, but there are issues that might arise later on we might not have known about. Are you willing to work through these issues? Some issues might be Housebreaking or litter box issues? |
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Yes
No |
| Barking? |
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Yes
No |
| Chewing? |
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Yes
No |
| Obedience training? |
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Yes
No |
| Activity Level? |
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Yes
No |
| Leash Training? |
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Yes
No |
| Fear of Men? |
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Yes
No |
| Fear of Women? |
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Yes
No |
| Fear of Children? |
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Yes
No |
| Fear of dogs and/or cats? |
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Yes
No |
| Fear of loud noises/thunder storms? |
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Yes
No |
| Submissive peeing? |
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Yes
No |
| Food/Toy aggression? |
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Yes
No |
| Separation anxiety and/or abandonment issues? |
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Yes
No |
| Scratching on furniture? |
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Yes
No |
| Which of the following medical issues that may arise in the future are you willing to provide medical care and deal with and which would cause you to return the pet to us? Please answer each with either deal with or return. Blindness? |
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| Deafness? |
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| Diabetes? |
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| Special Diet? |
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| Long term medications? |
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| Surgery and/or Dentals? |
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| Physical Therapy? |
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| Urinary Tract Blockages and/or infections? |
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| Any other medical that might not have been mentioned? |
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| Have
you ever owned a pet before? |
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Yes
No |
| Please
describe those pets that are currently with you (type (dog/cat/other), age,
sex, altered status, declawed, did you choose to have your pet declawed or did your pet come to you declawed? How long have you owned?)
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| Please
describe those pets that are no longer with you (type (dog/cat/other), age,
sex, altered status, declawed, did you choose to have your pet declawed or did your pet come to you declawed? How long did you own?) |
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| What
happened to the pets who are no longer with you? |
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| Have you ever taken a pet to a shelter or given a pet away? If so why? |
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| Have you ever had a pet run away or get lost? If yes please explain. |
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| Have you ever had a pet killed by a vehicle? If yes please explain. |
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Please
provide ALL the name(s) and phone number(s) of the veterinarian(s) for
your current and/or former pets. |
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| Do you know the number and location of the nearest emergency veterinarian clinic in case your dog/cat needs to be seen after hours? |
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Yes
No. |
| Is your current dog(s)/cat(s) on heartworm preventative? |
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Yes
No. |
| If yes what kind of heartworm preventative? |
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| Do you keep your pet on heartworm preventative all year round? |
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Yes
No. |
| Is your current pet(s) current on their vaccines? |
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Yes
No. |
| Does your current pet(s) receive a 1 or 3 year rabies vaccine. |
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| Do you take your pet(s) to your veterinarian yearly for a wellness check-up? |
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Yes
No. |
| Please estimate the amount you think it will cost yearly for the following: Food (Premium, not grocery brands), Grooming, Veterinarian Care (Including but not limited to annual wellness check-ups, vaccines, heartworm and flea preventative), Extras Such as Toys and Boarding or In Home Pet Care. |
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| Are you willing and able to provide pet care for the next 10 or more years including veterinarian care, boarding/in home pet care, unexpected medical care, exercising, and indoor housing? |
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Yes
No. |
| Are you willing and able to make a 10 or more year commitment to the pet you are trying to adopt? |
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Yes
No. |
| Will you take your new dog (if applying for a dog) to obedience classes? |
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Yes
No. |
| Are you willing to exercise your new dog (if applying for a dog) daily by taking them for a walk aprox. 45 min to 1 hour? |
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Yes
No. |
| How
many people reside in your household? |
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| Name and ages of adults in household? |
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| Are
there any children in the household? |
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Yes
No
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| If
yes, what are their ages?
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| Does
anyone have allergies to pets? |
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Yes
No. |
| Does anyone in your home fear dogs or cats? |
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Yes
No. |
| If yes please explain. |
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| Is everyone in the household in agreement on adopting a new pet(s)? |
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Yes
No. |
| If no please explain. |
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| Who
will be responsible for the care of your pet? |
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| Do
you own or rent your residence? |
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Own
Rent |
| If
you rent, please provide the name and phone number of your
landlord. |
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| Do you have permission from your landlord to own a pet(s)? |
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Yes
No. |
| Are there any restrictions to you owning a pet? If yes please explain what they are. |
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| Are you familiar with the animal regulations in your area? |
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Yes
No. |
| Are you planning to change your residence in the near future |
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Yes
No. |
| What will you do with your pet(s) if you move? |
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| What will you do if you are unable to find a place that will allow pets? |
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| Where
will your pet be kept? |
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Inside
Outside
Both |
| How many hours a day will your new pet have access to free reign of the home? |
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| How many hours a day will your new pet have access to the main floor of your home? |
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| How many hours a day will your new pet have access to the basement of your home? |
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| How many hours a day will your new pet (if a dog) have access to your backyard |
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| What provisions will be made for your pet when no one is home during the day? During the evening? Away on vacation? |
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Do you have a fenced in yard? |
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Yes
No. |
| Please describe your fence and height of fence. |
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| Do
you intend to declaw your cat? |
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Yes
No. |
| If you answered yes, please explain why you will choose to have your new cat(s) declawed.
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| What are your views on declawing? What do you believe the procedure to be? |
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| Do you believe in Spaying and/or neutering your pets? |
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Yes
No. |
| Please explain why you answered either yes or no to the above question. |
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| What would make you give up your new pet, or need to find it a new home?
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| How
did you hear about SPICER? |
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| Reference: |
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| Name: |
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| Phone:
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