Jackson Co AS Adoption Application

Jackson County Animal Shelter - Pet Adoption Application
Before you decide to adopt, please consider the time, effort, and funds necessary for food, supplies, and veterinary visits to properly care for your pet. Thank you for considering adoption instead of purchasing through a breeder.
Date*

MonthDayYear
Name of animal you want to adopt*
It is a*

Dog or PuppyCat or KittenOther
Describe animal wanted*
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
E-mail*
I am 18 years or older. (You must be 18 years old to adopt an animal.)*

YesNo
Please tell us the reason you want a pet.*
I live in a*

HouseMobile HomeApartmentOther
I currently*

OwnRentOther
If you rent, include name and phone number of landlord.
Do you have a yard?

Yard, completely fenced with a vertical fenceYard, partially fenced with a vertical fence (not an enclosed area)Yard, fenced with invisible/underground fencingYard, no fenceNo yard (apartment/condo/townhome)Other
If fenced, fence height is:*

2 feet tall3 feet tall4 feet tall5 feet tall6 feet tallNo fence or fenced area is not completely enclosedOther
Approximate dimensions of your lot*
Do you live with family/friends?*

YesNo
Are there any children in your home?*

YesNoOther
If yes, what are their ages?
Where will your new pet live?*

IndoorsOutdoorsMostly indoorsTied up outsideIn a fenced yardRunning freeMostly outdoorsOther
Do you understand that you must return the animal to the animal shelter if you cannot keep it?*

YesNo
Adopting a new pet brings with it a lot of responsibility, including annual vet care, vaccinations, and possible emergency care. This is more expensive than many people realize. Are you aware of and prepared to assume the responsibility for your newly adopted pet?*

YesNo
Is anyone in your household allergic to dogs or cats?*

YesNoOther
Are you aware a dog will destroy household items if not exercised on a daily basis?*

YesNoOther
What pets do you currently have?*

DogCatBirdSmall & furryChickensGoatsHorsesNoneOther
How many of each?*
Are your current pets fixed?*

YesNoNo current petsOther
Where are your current pets kept?*

InsideOutsideNot applicable, no current petsOther
Do you have a vet?*

YesNoOther
Vet Name*
Vet Phone*
How many hours a day will this pet be alone?*
Where will it be when alone?*
How did you hear about the animal you are going to adopt?*

WebsitesAdoption boardsWalk inAdopt-A-ThonOther
We reserve the right to refuse adoption to anyone. No animal will be adopted to prospective owners who mislead or fail to provide accurate information.*

I understand
The animals we have for adoption here come from a variety of sources. All animals are routinely monitored while at our shelter. However, there is always a chance that an animal may be incubating a disease without showing any clinical signs.*

I understand
I have seriously considered all aspects of owning a pet and I am aware of the time and money involved. I am prepared to make a commitment to this pet for its lifetime. I agree to keep this animal in accordance with all the applicable laws and ordinances of the community. I understand that filling out an application for the animal does not guarantee an adoption and the animal shelter reserves the right not to adopt.*

I understand and agree
I accept the responsibilities and liabilities that come with pet ownership. I waive any and all possible claims against the Jackson County Animal Shelter arising from the adoption of my pet.*

I accept and waive
Applicant's Signature*
Date*

MonthDayYear
Should be Empty:

Jackson County Animal Shelter - Pet Adoption Application