Animal Welfare of Surry NC

low cost spay neuter, adopt , dog, rescue, puppy

Animal Welfare of Surry Adoption Application

Animal Welfare Of Surry (AWS)

PET ADOPTION QUESTIONNAIRE

Pet ownership is a serious commitment and not one that should be taken lightly. The intention of this adoption questionnaire is to assure that adoptive families are committed to the responsibility of long term pet ownership morally,physically and financially. We want your family to be happy with your new companion.  The following questionnaire has been designed to aid both you and AWS in deciding if you/and or your family are a good match for the pet you are interested in adopting. Please be sure to answer all questions and feel free to add any comments. If a question does not apply simply put N/A.

The majority of pets we have for adoption are found abandoned or are pulled from area shelters in hopes of placing them with individuals/families willing to providing a safe,healthy,home environment for the remainder of pets life (which could possibly be 10 years+).

AWS is a nonprofit organization.  All fees paid to adopt any pet goes toward reimbursement of medical services and care provided.

If you are interested in adopting any of our pets, please submit an application.  We will contact you within a 24-48 hrs. with a reply regarding your application status.  Please copy and paste, then email your application to Melinda at jadehall21@yahoo.com.  We will acknowledge the receipt of your application.  If you DO NOT receive an acknowledgment please contact us at 336-755-6053 or 336-786-5256 to ensure we have received your application.  The more pets we are able to place, the more pets we are able to rescue!!

                                              AWS ADOPTION QUESTIONNAIRE

Pets name(s) and breed(s) you are most interested in:


Name, address, state,and town:

Phone number to reach you at:
 
Email address:
 

What is your reason for adopting a pet?
A) Companion for another Pet
B) Family Pet 
C) Child’s Companion 
D) Adult’s Companion
 
Do you live in a house, condo, trailer, apartment, other?
 
Do you rent or own?
 
If you rent, please list landlord’s information and phone number
 
Briefly describe your home.  
 
How many hours a day is someone home?

Where will the pet stay during the day?  
 
Where will the pet stay at night?
 
Is the yard fenced? If so, what type of fencing?  

Please list the ages of children that reside in your home:
 
Please list any other pets you have owned within the last 5 years.

Type and Names:

Age, when no longer owned.

General Health of Your Pet(s) 

If no longer owned, what happened?

Were/Are these pets spay or neutered?
 
Please explain where your current pet(s) spend the day.
Please explain where your current pet(s) sleep. 
 
If you have a "dog lot" or outdoor kennel, please explain when it is used for your pet(s). 
 
How much money would you plan to spend yearly on your pet?
 
What would be a reason for giving up your pet?  
 
f you had to give up your pet would you?
A) Take it to the nearest shelter
B) Give it to a friend or relative
C) Return it to the group/person you adopted from
(Shelters are county run facilities where unwanted pets are usually euthanized.)

What type of pet are you interested in?
A) Active and playful
B) Watch dog (would bark to alert)
C) Couch potato and quiet 
D) Guard Dog (would bite if provoked)

Please list your vet’s name and phone number. If you currently do not have one, please provide us with your previous veterinarian's information. Please also list who's name the records will be in at their office.
(VET REFENCE IS REQUIRED TO ADOPT.  YOUNG ADULTS MAY USE THEIR PARENTS VET FOR REFERENCE. SPECIAL CIRCUMSTANCES MAY BE CONSIDERED.)  If no vet reference, please explain why you do not have one.
 

How long have you used him/her?

List at least 2 personal references, and their phone numbers. (No more than one relative please.)
To expediate your application process, you may submit additional references to ensure that we can reach at least 2 in a timely manner.
 

 

May we do a  follow up call or visit?    Yes    No

 

Have you or anyone that visits or resides in your home ever been accused or convicted of animal abuse or neglect? 

 

Is there anything else you would like us to know or any of your answers that you feel need further explanation?

 

It is our policy that if this application is falsified or the pet you adopt from us is not being given the proper care(personal or veterinarian) we reserve the right to reclaim the animal without any reimbursement of any costs or services.  (This includes veterinarian care, heartworm tx, vaccines, flea treatment/preventative)

We realize that life circumstances change.  Would you be willing to contact AWS before placing the pet you adopt from us in another home if at any time this pet you feel that you can no longer care or provide for this pet?

 

Your signature authorizes Melinda Mills to contact your references and verify all information provided on this application. Please realize any inaccurate or incomplete information can be reason for refusal. We reserve the right to check all home addresses via public access GIS, and other public access applications.

Signature:

Print Signature:

Date: 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

 

 

 

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