Adoption Application

I have read and understand the information about Pre-Adoption Considerations above.

Animal Name:
Today's Date:

The Animal Care Shelter for Kent County Maryland, Inc., reserves the right to refuse adoption of an animal to anyone who falsifies information or fails to comply with ACSKC’s standards of animal care. Failure to provide complete information may result in delays in processing or denial. It is at the sole discretion of the ACSKC to determine the appropriate match with the type of home that best provides for the specific animal’s needs. PLEASE COMPLETE ALL INFORMATION BELOW

Last Name*
First Name*

Spouse/Roomate
Are they in agreement to adopt? YesNo

Home Phone*
Work Phone
Cell Phone*

Email Address*

Street Address*

City/State/ZIP*

County of Residence*
How long have you lived at this address?*

Type of Home*
Single Family HomeApartment/CondoTownhouseMobile HomeFarm Home

Do you: RentOwn
ACSKC will check property records to ensure ownership
If renting, landlord's name:
Phone

Your Occupation*
Employer*

Spouse's/Partner's Occupation
Employer

Please list two references who can bear witness to your ability to be a responsible pet owner:

(Please note: only one of your references may be a family member)

Name*
Phone Number*
Relationship*

Name*
Phone Number*
Relationship*

Please list all pets that currently live with you:

Name
Breed/Type
Age (in years)

Sex:MaleFemale
Altered:YesNo
Where Kept:InOut

Name
Breed/Type
Age (in years)

Sex:MaleFemale
Altered:YesNo
Where Kept:InOut

Name
Breed/Type
Age (in years)

Sex:MaleFemale
Altered:YesNo
Where Kept:InOut

Name
Breed/Type
Age (in years)

Sex:MaleFemale
Altered:YesNo
Where Kept:InOut

Name
Breed/Type
Age (in years)

Sex:MaleFemale
Altered:YesNo
Where Kept:InOut


Name of current veterinarian:
Phone:

Please list PREVIOUSLY owned pets (within past 5 years)

Name
Breed/Type
Years Owned

What happened to this pet?:

Where Kept:InOut

Name
Breed/Type
Years Owned

What happened to this pet?:

Where Kept:InOut

Name
Breed/Type
Years Owned

What happened to this pet?:

Where Kept:InOut


Veterinarian for previously owned pet(s):
Phone:

How did you hear about our shelter / this animal?*

PLEASE ANSWER THE FOLLOWING:

1. Is this your first experience owning a pet?*YesNo

2. Your reason for adoption?*
Check all that apply
House PetGuard DogGiftFor ChildTo BreedFarm petCompanion For Another PetOther         

3. How many hours each day will the cat/dog be left alone?*

4. Where will the cat/dog be kept when you are gone?*

5. How do you plan to keep this animal contained on your property?*
Check all that apply
Outdoor KennelIn The HouseIn A GarageFenced YardTrolley SystemInvisible/Underground FencingOn Patio/PorchOther         

6. If you have fencing, please describe the type and height:

7. If there are children living in the household, how many? Ages?

8. Does anyone in the household have animal allergies?*
YesNo
If yes, how do you plan to manage this?

9. Our adoption contract states that you will take this cat/dog to a vet within 10 days. You will be responsible for any medications or treatments the animal requires.
Do you understand and agree to this?*
YesNo

10. If you are adopting a cat, do you plan to declaw?*
YesNo

11. If you are adopting a dog, do you plan to crop ears or dock tails?*
YesNo

I, hereby grant permission to The Animal Care Shelter for Kent County Maryland, Inc., to contact my veterinarian, local animal control agency, and references to obtain information related to my current and previously-owned pets in order to verify information on this application.

Name*
Date*

I hereby certify that the information provided above is true and complete to the best of my knowledge.