Pet Adoption Application

Save-A-Pet Animal Rescue and Adoption Center wants to remind adopters that mature animals are calm, well-behaved, and often already trained. They are ready-made family members just waiting for a home to call their own. Please consider an older animal for your next companion!

Download our Adoption Application as a pdf or fill out this form:

I'd like to adopt a Dog Cat

Name of Animal:

View our Adoption Center in a separate window.

 
* Name:

 

* Address:

* City:

* State: * Zip:

* Home Phone:

() -

Cell Phone:

() -

* Email Address:

 
Please answer ALL of the following questions:

Are you over the age of 21? Yes No

Do you Own Home Rent

If you rent, please tell us your landlord's name and phone:

Landlord Name:

Phone Number:

() -

 
How many adults are in the household?

How many children are in the household?

What is the age range?

 
About many hours a day will the animal be alone?

Are you against crate training? Yes No

Do you believe in declawing? Yes No

Do you have a fenced yard? Yes No

If so, what kind of fence? How high?

 
Where will the animal be kept. . .
    during the day? Inside Outside Both
    at night? Inside Outside

 
Have you ever adopted a pet from us before? Yes No

Have you ever surrendered a pet to us before? Yes No

If so, when and why?

 
Do you currently own any animals? Yes No

If so:

Names:

Breeds:

Sex:

Ages:

Spayed/Neutered: Yes No

 
Have you owned any animals in the past? Yes No

If so:

Names:

Breeds:

Sex:

Ages:

Spayed/Neutered: Yes No

 
What is the name of your Veterinarian?

What is their phone number? () -

May we contact them for a reference? Yes No

 
Please provide two personal references:
(NO FAMILY MEMBERS)

Name:

Relationship:

Phone Number:

() -

 
Name:

 

Relationship:

Phone Number:

() -

 
Do you object to a home visit? Yes No

 
I understand that:
1. Save-A-Pet has the right to refuse to adopt any animal.
2. I will be required to pay an adoption donation for this animal.
3. If the animal is a dog, I will be required to purchase a New York State (or otherwise if out-of-state address) license for this pet.
4. I will be required to have any un-spayed/un-neutered dogs that I adopt, spayed or neutered at Save a Petís expense and will call to make an appointment at the appropriate time (designated by Save-A-Pet).
5. Save-A-Pet has had preliminary veterinary care for the animal but makes no claims as to the future health of the pet.
6. I promise to bring the adopted pet to my veterinarian for regular check ups and when the animal is in need of medical attention.
7. The pet will live INSIDE the house with you and WILL NOT be kept outside.
8. I agree to return the animal to Save-A-Pet, if, for any reason, I decide not to keep the pet.
9. Save-A-Pet may seize the animal if we become aware that the animal is being mistreated or neglected in any way or if the terms of this agreement have been violated.

* I understand the above

I would like to receive emails from
Save-A-Pet Animal Rescue

* Type the code in the box below:

 

608 Route 112, Port Jefferson Station, NY 11776 • p. 631.473.6333 • f. 631.978.0100