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Adoption Inquiry
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This form has been modified since it was saved. Please review all fields before submitting.
Thank you for considering the adoption of one of our wonderful animals. Understand that this can be a 10-15 year commitment to this animal. Our goal is to make the best possible match between people and animals. By answering the questions below, you will help us achieve the best possible match for you and your new companion.
This inquiry only demonstrates that you are interested in a particular animal for adoption and does not guarantee adoption.
Animal ID Number
*
First Name
Last Name
Email
*
Address1
Address2
City
State
Zip
Home Phone
*
Cell Phone
*
Work Phone
Residence Type
*
-- Select One --
House
Apartment
Condo
Other
If Other, please explain:
You currently...
*
-- Select One --
Own
Rent
Rental Notice
If you rent, the Norfolk Animal Care Center reserves the right to verify your landlord's current pet policy.
Name of Property Owner
Property Owner Phone Number
How many adults live in your home?
*
How many children live in your home?
*
Ages of Children
Does anyone in your home have allergies to animals?
*
-- Select One --
No
Yes
Who will be primarily responsible for this animal?
*
Is this animal a gift?
*
-- Select One --
No
Yes
If yes, for whom?
Which of the following best describes your reasons for adopting a shelter animal? (Check all that apply)
*
Companion for me
Companion for other pet
Guardian/Security
Hunting
Couch Potato
Agility/Obedience
Jogging/Walking Partner
Education
Barn Cat/Mouser
How many hours will the animal be left alone during the day?
*
Where will the animal be kept when no one is home?
*
Where will the animal be kept at night?
*
Please list the last four (4) pets that you’ve owned, including ones you currently still have:
Name
Type of Animal
Age
Sex
Still own? If not, please explain:
Name
Type of Animal
Age
Sex
Still own? If not, please explain:
Name
Type of Animal
Age
Sex
Still own? If not, please explain:
Name
Type of Animal
Age
Sex
Still own? If not, please explain:
Do you have a veterinarian?
*
-- Select One --
Yes
No
Name of Veterinarian/Clinic
Are resident pets current with vaccines and city licensing (if applicable)?
*
-- Select One --
Yes
No
Your adoption counselor with discuss the following with you:
- New Home Adjustments - Health/Veterinary Care - Expense - Identification - City Pet Laws - Potty/Litter Training - Daily Care Requirements - Feeding - Behavior Problems and Training
Do you have any other questions or concerns about your new companion?
*
How did you hear about NACC?
*
-- Select One --
Social Media
NACC website
Walk-In
Referral
Finder
TV Advertisement
Newspaper Advertisement
I agree to the release of my contact information to Friends of the NACC, the non-profit group that helps to support the shelter with funding for adoptions, medical support, and promotional purposes related to NACC.
*
Yes
No
By signing below, I certify that the information I have given is true and that I recognize that any misrepresentation of the facts may result in my losing the privilege of adopting a pet. I understand that the Norfolk Animal Care Center has the right to deny my request to adopt an animal, and I authorize the investigation of all statements in the application.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
This inquiry only demonstrates that you are interested in a particular animal for adoption and does not guarantee adoption.
Electronic Signature Agreement
*
I agree
Electronic Signature
*
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