COLUSA COUNTY ANIMAL SHELTER

COLUSA COUNTY ANIMAL SHELTER

ADOPTION APPLICATION

WELCOME TO THE COLUSA COUNTY ANIMAL SHELTER.

The following information is requested so that we may assist you in the selection of a new pet. The animal’s welfare is our foremost consideration. This application is designed to help us determine if the adoption is in the animal’s best interest, and to assist you in finding an animal most compatible with your lifestyle.

The animals available for adoption came here for various reasons. There is always a chance that an animal is incubating a disease without showing any clinical signs.

The fees are as follows: Adoption - $10.00, Spay/Neuter deposit: Dogs - $50.00: Cats - $40.00. The animal must be spayed or neutered within thirty (30) days from the date of adoption.

You will be asked to send us a veterinarian’s certificate or receipt verifying that the animal was spayed or neutered. Your deposit will be returned to you at that time.

IN ORDER TO BE CONSIDERED AS AN ADOPTER, YOU MUST:

· Be 18 years of age or older;

· Have identification showing your present address;

· Have knowledge and consent of your landlord;

· Be able and willing to spend the time and money necessary to provide training, medical treatment, humane care and living conditions for the life of your pet.

NAME____________________________________________________ DATE____________________

ADDRESS___________________________________________________________________________

CITY_________________________________________ STATE________ ZIP__________________

HOME PHONE________________________________ WORK PHONE_______________________

(Required)

CELL PHONE_________________________________

The Colusa County Animal Shelter reserves the right to refuse adoption to anyone. No animal will be adopted to persons having a history of neglect, not giving humane or veterinary care, losing, giving away, selling, or having animals injured or killed by moving vehicles or staged fights. No animal will be adopted to prospective owners who mislead or fail to provide accurate information on the adoption application.

Ccas/aap/07 rev.

PLEASE FILL OUT THE FOLLOWING QUESTIONNAIRE:

1. What kind of pet are you here to adopt?

_____ Dog ____ Puppy ____ Cat ____ Kitten

2. Why do you want a pet?

____________________________________________________________________________________________________________

3. Do you have any preferences as to breed, sex, age, size, length of hair etc? _____________________

____________________________________________________________________________________________________________

4. Have you adopted a pet from a shelter or rescue group before? ______Yes _______No

If yes, please list the name___________________________________________________________________________

5. List the pets you have previously owned:

TYPE SPAYED/NEUTERED KEPT WHERE? YEARS WHAT HAPPENED

OWNED TO THE PET?

____Dog ___Cat _____Yes _____ No ____In _____Out __________ __________________

____Dog ___Cat _____Yes _____No ____In _____Out __________ ___________________

____Dog ____Cat ______Yes _____No ____In _____Out __________ ___________________

6. List the pets that are in your home now:

____Dog ____Cat Spayed/Neutered? ____Yes ____No Kept Where? ____In ____Out Age ________

7. List the breeds of the dogs and cats that you have owned or that currently live at your residence________________________________________________________________________________________________

8. Do they have a current Rabies vaccination? _____Yes ______No

If YES, what county did they receive their Rabies tag & dog license______________________________

9. Who is your veterinarian?____________________________________________________________________________

City/State___________________________________ Phone ______________________________________________

10. Do you currently live in a ______house ____ apartment ____mobile home

11. Do you live ________in town ________on a ranch

12. Do you _______own or ________rent

13. If you rent, does your lease allow pets? ____Yes ____No

14. If you rent, what is your landlord’s name? ______________________________________________________

Phone #_____________________________________

15. How long have you lived at the above address? _______________________________________________

16. How many people live in your household?______________________________

Do all the adults know that you plan to adopt? _______Yes _________No

If there are children, what are their ages?______________________________

17. Are the children afraid of dogs or cats? ________Yes __________No

18. Who will be responsible for the care of this pet?__________________________________________________

19. Where will this pet be kept during the day?___________________________ Night?____________________

20. How many hours a day will it spend alone without human companionship?_____________________

21. Where will it be kept when alone? ____In house ____Kennel ____Fenced yard

____On Chain ______Garage

22. You are adopting this animal for yourself and the animal will live at the address that you have given _________Yes ______No

DOG ADOPTIONS ONLY:

23. Do you want the dog for a: ____family pet ____ watch dog ____ companion

_____company for other pet

24. Do you have a fenced yard? ____Yes ____No If YES, how high?______________________________

25. Do you realize you will probably have to house train your new puppy or dog? ____Yes ____No

26. Do you realize this adopted animal may wander because it will not know where “home” is therefore should not be “off leash” for several months _______Yes ______No

27. Are you familiar with the leash and licensing laws in your community? ____Yes ____ No

28. What will you do if your dog chews shoes or shows other destructive behavior? _______________

___________________________________________________________________________________________________________

29. How do dogs get heartworm disease? How can you prevent it?______________________________

_____________________________________________________________________________________________________

30 How can you prevent your puppy from getting Parvo?_______________________________________

_____________________________________________________________________________________________________

31. How will you keep your dog confined to your property? (check all that apply)

____ In house _____ Kennel _____ Fenced yard ____ On chain _____ Garage

_____ Patio _____ On leash

CAT ADOPTIONS ONLY:

30. Do you want the cat for a: (check all that apply)

_______family pet _____ mouser _____ companion ______ company for other pet

31. Will this cat be allowed outdoors? _____Yes _____No

If YES, under what circumstances?______________________________________________________________

32. Do you understand that this cat may wander because it does not know where “home” is and it may become lost if left outside unattended? _____Yes _____No

33. What will you do if your cat claws the furniture, doesn’t use the litter box, or shows other

destructive behavior?

____________________________________________________________________________________________________

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FOR SHELTER USE ONLY ~ DO NOT WRITE BELOW THIS LINE. THANK YOU

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Landlord Approval_______________________________________________________________________________________

Residence Check on Driver’s License __________________________________________________________________

Veterinary Reference ___________________________________________________________________________________

Approval_________________________________________________________________________________________________

Adoption Reviewed By __________________________________________________________________________________

( Two signatures ) __________________________________________________________________________________