Canine Adoption Application

Hanna & District Society for the Prevention of Cruelty to Animals, hereby known as the Hanna SPCA

To be considered as a potential adopter, you must:

Be at least 18 years of age
Have identification containing your address
Have the knowledge and consent of your landlord and show written proof (if applicable)

Completion of this form DOES NOT guarantee adoption of a Hanna SPCA animal.

Contact Information:

Name:_____________________________________

Date:_________________________

Phone#:

Day_______________________________

Cell_________________________________

Address:

Street (& P.O. Box if applicable)_________________________________________________

City & Province___________________________________

Postal Code________________

May we contact you by Email? Y / N

Email:________________________________________________________________

Canine(s) Applying For:_______________________________________________________

How did you hear about the Hanna SPCA?

www.hannaspca.com ___ Kijiji___ Hanna SPCA Facebook Page___ Word of Mouth___

Other (please specify):_______________________________

The information you provide is strictly confidential and will not be shared with anyone outside the Hanna SPCA unless permission is granted by the applicant.

Please provide 3 references (co-workers, veterinarian, pet-sitters, etc.):

Name:________________________________________

Relationship:_____________________

Phone (day):___________________________

Phone (cell):_____________________________

Name:_______________________________________

Relationship:______________________

Phone (day):___________________________

Phone (cell):_____________________________

Name:_______________________________________

Relationship:______________________

Phone (day):___________________________

Phone (cell):_____________________________

Do all adult members of the household know that you plan to adopt a pet? Y / N

Who will be responsible for this animal? ____________________________________________

Previous to adoption approval, are you willing to allow a Hanna SPCA representative to come and see where the animal will be living? Y / N

Please indicate your type of residence: House_______ Apartment_______

Other (specify)_________________________________________________

Do you: Own_______ Rent_______ Other (specify)___________________________________

If you rent, do you have written permission from your Landlord to have a pet? Y / N

How long have you lived at your current address? ____________________________________

Do you anticipate moving within the next 6 months? Y / N

Do you have children at home? Y / N

Have you had or do you now have pet(s)? Y / N If yes, what did/do you have? ______________________________________________________________________

How long have you had them? ______________________________________________

If you no longer have them, why? ________________________________________________

Spayed/neutered? Y / N Vaccinations kept current? Y / N If no to both or either of these questions please explain:_________________________________________________________

Will your other pets accept this new pet (if applicable) Y / N

Where will this animal live? Sleep? o to the bathroom?

House House Yard

Shop/Barn Shop/Barn Pee-Pads

Outdoors Outdoors On walk

Crate

Why do you want to adopt a pet? __________________________________________________

_______________________________________________________________________

Is anyone in your house allergic to animals? Y / N If yes, specify: _________________________

_______________________________________________________________________

What would you do if your pet shows some behavioral problems such as barking, biting, eliminating in the house? _________________________________________________________

Under what circumstance would you give up your pet? _________________________________

Are you aware that pet care can cost approximately $600/year for food, supplies & vaccinations, not including unexpected medical care? Y / N

Do you agree that you will not have any type of cosmetic alterations (examples; tail docked, ears cropped, etc.) done to the dog(s) you are adopting? Y / N

Should any such procedures be done to the animal(s) you understand that such action will render the adoption void and the animal(s) will be returned into the care of the Hanna SPCA Y / N

Dogs often live longer than 12 years are you prepared to take on that responsibility? Y / N

Do you agree to provide a good permanent home, sufficient food, water, shelter and medical care and humane treatment for the animal(s) at all times? Y / N

These animals are very important to us and we want to do all we can to make the transition from the Hanna SPCA to your home as easy on the animal(s) as possible. As such we may contact you for an update to help ensure that the animal(s) successfully adjust.

Do you consent to a phone call from a Hanna SPCA representative after adoption? Y / N

It is the Hanna SPCA policy that any animals adopted out that must be given up by an adoptee, for whatever reason, must be returned to the Hanna SPCA. Do you agree to abide by this policy? Y / N

Adoption Agreement:

By signing below, I certify that the information I have provided is true and correct. I understand that any misrepresentation of facts may result in my losing the privilege of adopting a pet from the Hanna SPCA.

I understand that the Hanna SPCA cannot guarantee the health, temperament or training of the animal(s) and I hereby agree to release the Hanna SPCA from all liability once the animal(s) are in my possession.

I agree that I am obligated to make arrangements to return the animal(s) to the Hanna SPCA so that said animal(s) can be re-adopted with the full knowledge that the adoption fee(s) paid will not be refunded to me.

Upon adoption I agree to pay the adoption fee of $________ to the Hanna SPCA for the adoption of the animal(s) described as follows:

Name(s) and I.D.# while at shelter:

_________________________________________________

_______________________________________________________________________

Tattoo # (if applicable):___________________________________________________________

Date of Birth (note if an estimate):__________________________________________________

Physical Description of Animal(s):___________________________________________________

_______________________________________________________________________

Adopter Name (please print):____________________________________________________

Signature:___________________________________________

Date:____________________

Hanna SPCA Representative (Print Name):___________________________________________

*Please note that the Hanna SPCA reserves the right to refuse adoptions.

Subject to the provisions of this form and the information provided the Hanna SPCA agrees to allow the adoption of the following animal(s):

Shelter I.D. # and Name at Shelter:

______________________________________________________________________

Adoption Approved By:

Hanna SPCA Representative:

Signature:______________________________________ Date:______________

Print Name:_____________________________________

Hanna SPCA Board Director:

Signature:______________________________________ Date:_______________

Print Name:_____________________________________

Email: Website: FaceBook: Hanna SPCA

P.O. Box 2126 Hanna, Alberta T0J 1P0

321 - 3rd Avenue East

(403)854-3700