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ACC Adoption Application

Please Note: YOU MUST BE AT LEAST 18 YEARS OF AGE TO FILL OUT THIS APPLICATION. INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED!!

* PLEASE MAKE SURE YOU COMPLETE
** IF YOU ARE A FIRST TIME PET OWNER OR YOU DON'T HAVE A VET FOR YOUR PRESENT PET, YOU MUST COMPLETE.

 
*Name Of Pet You Are Interested In
ACC Contact Person
PERSONAL INFORMATION
*Name:
*Address:
*City: *State: *Zip:
*Phone
Day: Evening:
*E-mail:
FAMILY INFORMATION
List all members of your household and your relationship to them and the ages of all minors.
NameRelationship to ApplicantAge(if minor)
(If you need more room, please show other household members in the comments section.)
*Is everyone in your home in agreement to adopt this pet Yes No
*Are you aware that there is a set adoption donation Yes No
CURRENT PET INFORMATION
*Do you currently own any dogs? Yes No
Name(s)
Age(s)
Breed(s) & Size(s)
Spayed or Neutered Yes No
If no, give reason why
*Do you currently own any cats? Yes No
Name(s)
Age(s)
Spayed or Neutered Yes No
If no, give reason why
*Did you ever give up a pet Yes No
If yes, give reason why
*Did you ever put a pet in a shelter Yes No
If yes, give reason why
*State the type of Dog or Cat food you use
VET INFORMATION
Vet Name:
Vet Address:
Vet Phone:
Under whose name are the above pets registered with the vet?
HOME INFORMATION
* Own Home Rent Home
Name of Homeowner or Landlord
Address
LandLord Phone Number
Fenced In Yard (Height & Style)
PET INFORMATION
*Will Your New Pet Be A Lifetime Commitment Yes No
If adopting a cat will you declaw the cat Yes No
Where Do You Plan On Keeping Your New Pet
Where Exercised
Home During Day Yes No
Who Is Home
How many hours a day will pet be left alone
JOB INFORMATION
Employer
Employers Address
Name and Phone Number of two Personal References. Please include E-mail Address.

**Personal Reference #1
Name:
Phone:
Email:
Personal Reference #2
Name:
Phone:
Email:
COMMENT
State briefly why you want a pet
By checking the box below I further certify that the information I have provided on this form is true, correct, and accurate.