Jefferson County Spca Foster Forms

If for ANY REASON I am unable to provide for this pet I will return him/her to the Jefferson County Humane Society I understand that approval of this application is strictly at the discretion of the Jefferson County Humane Society. SignedDate P. O. Box 2233 Pine Bluff Arkansas Phone 870-247-2677 Fax 870-247-2409 Fax between the hours of 8am and 8pm CST. Jefferson County Humane Society Better Options for Neglected Strays ADOPTION AGREEMENT QUESTIONAIRE Date Animal Name Applicant Name Physical Address PhoneCell Phonee-mail Do you live in a circle one househouse Apartment Other For how long this address If you rent do you have your landlord s permission to have this pet YesNo Your landlord s name and phone number Address If not already done would you have this pet spayed or neutered before it is 6 months old Do you have children Yes No How many Ages Where will this pet live Inside Outside Where will it sleep If outside what kind of shelter will it have Do you have a yard YesNo If yes is it fenced YesNo What type of fencing How high Will this pet be tethered tied or chained YesNo What would you do if a behavior problem developed How would you discipline this animal Are you getting this pet as a companion pet working dog guard dog other How many hours a day will this pet be alone Please list animals you have owned in the last 10 yrs along with their name Species How old/Animals name How long Current status Name /address/phone of your vet if you don t have a current vet you must have one in place before adopting the animal Would you be willing to have your vet information released to us Are you willing to care for this pet for the rest of it s natural life Yes No have an amputation become incontinent or other disability If your animal became ill how much would you be willing to spend for vet care Can you afford to provide medical care vaccines etc food and necessities YesNo Most counties require that a dog be confined to it s owner s yard or under direct control at all times. Would you comply Yes No Would you agree to keep an identification tag on this pet at all times to insure it s safe return if it should become lost Yes No adjustment to it Are any household members allergic to the type of pet you are applying for YesNo allergic Who will be responsible for this pet on a daily basis Who will be the responsible party while you are away Name/Phone Have all household adults agreed to adopting this pet Please list family members If applying for a puppy or kitten are you willing to put up with barking crying potty training chewing obedience lessons etc* that come with raising a baby YesNo For dogs and puppies Do you know what heartworm infection is Could we see this pet by appointment Yes No List three references not currently living with you and please do not list relatives whom we may contact Name address phone number. Our Jefferson County Humane Society promise to you is that for any reason you cannot keep/care for this animal in the future ever we will take this animal back and provide for it and returned to the Society at the adopter s expense.