Name
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First Name
Last Name
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email
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Home Phone Number
(###)
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Cell Phone Number
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(###)
###
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Employer
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Work Phone Number
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(###)
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Name or description of pet you are interested in adopting
Age of Pet (if known)
How did you hear about this pet?
Stopped by the shelter
Website
Social media (facebook, instagram)
Word of mouth
Newspaper
Other
Describe your residence
House
Apartment
Duplex
Mobile home
Condo
Other
Do you currently...
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rent
own
lease
live with your parents
How long have you lived at your current residence?
Landlord or Parent's Name
Landlord or Parent's Phone Number
(###)
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*REQUIRED: If not the property owner, the Sumter S.P.C.A. has my permission to verify the current pet policy with my landlord or parent.
How many adults live in your home?
How many children live in your home? Ages?
Does anyone in your household have pet allergies?
Yes
No
Not sure
Who will be primarily responsible for the care of this dog?
Will this pet be living at your residence?
If no, please state why below.
Is this pet a gift?
(If you answered yes to the previous question)Who is this pet a gift for?
What size dog are you interested in adopting?
Small
Medium
Large
Extra large
Which of the following best describes your reasons for wanting this dog? (check all that apply)
Where will this dog be kept during the day?
If kept outdoors, what kind of shelter will be provided for the pet?
How many hours a day will the dog be left alone?
Where will this dog be kept when no one is home?
Where will this dog be kept at night?
Do you have a fenced in yard?
Is your yard fenced in on all sides and completely closed in?
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Select an answer below if you answered NO to the previous question
Entire backyard is fenced in
Entire frontyard is fenced in
Both front & backyard are entirely fenced in
What type of fencing do you have? (select all that apply)
How high is your fence?
If you do not have a fenced in yard, how do you plan to contain the dog in a safe & secure manner while providing the proper amount of exercise?
Have you adopted from us in the past?
Do you still have the pet(s) you adopted from us?
If no, please state why below.
Please list ALL the pets you have had in the last 10 years, adopted or not, living or deceased. Please answer ALL questions!
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For each pet, please provide the following information: Breed/Sex/Age/Neutered or Spayed Status/Years Owned; Does this pet still live with you? If no, why?; Is this pet deceased? If so, what were the circumstances of their death?
If you have other pets, are their vaccinations current?
Who is your regular veterinarian?
Do you give us permission to check your current or past pet's medical history with your veterinarian?
Under what circumstances would you NOT keep this dog?
If you were to relocate, what would you plan to do with this dog?
Who will care for this dog if you are on vacation/out of town?
A pet lives from 12-20 years. Preventive veterinary care can cost from $100 - $200 or more per year. This includes booster vaccines and being kept free of intestinal parasites, fleas and ticks. Additional expenses are heartworm preventative, food, and veterinary care in case of illness or accident. Some shelters have unknown health backgrounds and behaviors. Are you willing to give the love your new pet needs and to assume its financial and training or restraining responsibilities?
Have you ever turned a pet into an animal shelter?
Please provide an explanation if you answered YES to the previous question:
✴I certify that the above information is true and correct to the best of my knowledge. I also acknowledge that falsification of the above responses can result in the denied adoption of an animal to me or can result in the return to the Sumter SPCA of an adopted animal. I understand and agree that the Sumter SPCA does not guarantee the health or temperament of the animal once it leaves the shelter. All dogs are required to be spayed or neutered. I understand and agree to abide by the S.P.C.A. policy that states, “The S.P.C.A. reserves the right to refuse any adoption of any animal for any reason deemed appropriate by the Sumter S.P.C.A.”
Please provide your digital signature below.
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