First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
 - 

Email*

Home Phone

Cell Phone

Place of Employment*

Occupation

List all of the residents of the household (include ages of children)

Do you own or rent your home
Choose one: Rent Own

In what type of home do you live*
Choose one: Single Family Duplex Apartment Townhouse Condominium Mobile Home Military Housing

Length of time at address*

If you rent, please enter your landlord's name and phone number

If you rent, have you received the approval of your landlord to have an animal?
Choose one: Yes No

If you rent, are there rules/restrictions regarding pets in your residence?

If you are renting we will ask you to email us a copy of your lease with a pet clause showing that your landlord has given approval to add a pet to your residence.

Where will the animal be kept?*

Do you have: (press the control key to select more than one option)

Is your yard fenced?

What type of fence
Choose one: Privacy Chain Link Invisible

What is the height of the fence

Time away from home:*

Are all the adults in your household aware and in favor of adopting a pet?*

Does anyone in the household have allergies to dogs/dander/hair/saliva?*

To the best of your knowledge, has any member of your household ever been convicted of an animal welfare law violation such as neglect, cruelty, abandonment, etc? If yes, explain.*

Please describe your experience with dogs:*

Please describe the ideal dog for your family:

Do you prefer:

Please describe your home atmosphere:*

The pet I'm interested in adopting must get along with: (select all that apply)

Name of the animal you are interested in adopting*
Choose an animal: Bandit Bix Brandy Buddy Chicken Coco Cow Dolly Dot Eloise Rodrick Roxi Scout Sparky Suki Tango

How did you hear about us? If a specific SVPP volunteer referred you, what is their name?

Please list all pets currently residing in your home. Include name, species, breed, gender, age, spayed/neutered?, where kept, length of time you've owned the pet.

ex: Buddy -- dog, chi mix, 5 yrs old, neutered, inside/outside, 5 yrs.

Current Pet #1

Current Pet #2

Current Pet #3

Current Pet #4

Are all your current pets up-to-date on vaccinations?*

Current Veterinarian (or expected vet, if you do not currently have a pet) contact information:

Please list all past pets for the past 10 years. Include species, breed, spayed/neutered?, where kept, years pet was with you, reason no longer with you, vet used.

ex: Sammy -- cat, siamese, female, spayed, indoor, 16 yrs, euthanized for health reasons, Pinnacle Vet Hospital

Past Pets

Past Pet #2

Past Pet #3

Have you ever surrendered a pet? If so, what was the reason?*

Who in the household will care for the pet*

Where will the animal be kept when you are not home*

Describe what methods you will use to train the pet:

What will you do to provide mental stimulation and exercise for your dog? What kind of activities will you do with the dog?

What do you see as normal, typical dog behavioral problems?*

What level of grooming responsibility are you willing to accept in association with your new dog?

If necessary, what housebreaking techniques will you use to train your dog?*

What will you do if the animal does not get along with present pets?*

What will you do with the new pet if you have to move?

What will you do with the new pet if you go on vacation?

What will you do with the new pet if you are expecting a child?

Will you have annual veterinary check-ups for your pet?*

Will you give your new dog heart worm tablets/flea and tick preventatives?*

How much do you estimate it will cost to own this animal per year?*

Are you willing to be financially responsible for updating vaccinations and emergency care for your pet?*

Are you willing to work on possible problems ex. chewing, inappropriate elimination, etc?

Can you afford emergency veterinary expenses?*

What do you consider acceptable reasons to give up a pet?*

Our goal is to find permanent, secure and attentive home for our rescued animals, and as such, all adoption applications will be reviewed thoroughly. Completing this application is in no way a guarantee that you have been approved for adoption. Silicon Valley Pet Project reserves the right to decline an application without releasing our reasons why. Please also be aware that a home check is a necessary part of our adoption process.

PLEASE READ CAREFULLY. Although Silicon Valley Pet Project does its best to pick out the healthiest of animals rescued, we cannot guarantee the health of the animals offered for adoption. Any time you adopt an animal, you should take it to a licensed veterinarian as soon as possible, in order to start it immediately on a program of preventative vet care. Be aware that the animals available for adoption are rescues and may have been exposed to (or may have) an upper respiratory infection or other illness or diseases. These disorders can have an incubation period of up to several weeks. If the animal you adopt shows signs of illness at any point, you must take it promptly to your veterinarian for treatment at your expense.

I certify that the information entered on this application is true and I have read and understand this disclaimer. Enter your name and today's date:*