SBARC Pet Adoption Application

Pet Adoption Application
To ensure that this adoption is in the best interest of you, your family, and the animal you select, we ask that you answer the following questions completely and honestly.

Adoptable animals can be found here on PetFinder
Type of animal are you looking to adopt:*
Name of animal you are looking to adopt:*
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState

Zip Code
How long have you lived at this address?*

Less than 1 year1-3 yearsMore than 3 years
Previous Address*

Street Address

Street Address Line 2

CityState

Zip Code
Please List 2 Personal References*
ReferencesString
Have you ever turned in a pet to an animal shelter?*

YesNo
What was the reason?*

Household Information
What type of home do you live in?*
Do you own this home?*
Permission from the property owner is required to complete your application.

Please provide contact information and documentation (rental agreement, contract, etc) from landlord, rental agency, or property owner to verify the pet policy of your residence.
Landlord/Property Owner Information*

Full NamePhone Number
Pet Policy Documentation*

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People in the Household
Please List the Name and Age of ALL Adults in the Household:*
Please List the Name and Age of ALL Children in the Household:
AdultsString
ChildrenString
Is everyone in the household aware that you are adopting an animal?*

YesNo
Why Not?*
Do you have a fenced in yard or dog run?*

YesNo
Please describe the enclosure, including dimensions of the fence/run:*

Pet Ownership Information
Are there currently other pets in the household?*

YesNo
Please List ALL Pets Currently in the Household:*
Not including current pets, have you had any other pets in the past?*

YesNo
What Happened to them?*
How will you discipline your new pet?*
What will you do if your new pet shows destructive behavior?*
What behaviors would you be unable to accept and possibly return him/her to us?*
How will your new pet be kept from running loose?*
What will you do with your new pet if you move?*

Veterinarian Information
How much do you anticipate spending on your new pet per year?*
Are you financially prepared to provide this pet care and commitment? (i.e. Medical care, food, heartworm prevention, flea prevention, etc)*

YesNo
Current or Most Recent Veterinarian for Pets :
Please Upload Most Recent Vaccination Records for ALL Pets in Household:

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If you plan on using a different veterinarian in the future, please provide that information:

Submit Application

Please review the terms and conditions below
Please read the following conditions or terms:

I will abide by all Local, State and Federal laws that pertain to my new pet.

I will not to allow my pet to become a public nuisance because of loud or frequent barking, biting or intimidating passersbys, running loose or any other behavior that may infringe upon the rights of others.
I realize that I must IMMEDIATELY remove and properly dispose of any waste from my pet on any property.

I understand that any comment that an animal may be good with children or other animals or is housebroken is based upon information provided by the previous owner if previous owner is known.
I will have my pet neutered by the date specified in the Spay/Castration agreement.

I will have my new pets health checked by a licensed veterinarian within 72 hours of the adoption.

I will provide proper and sufficient food and fresh water daily to my new pet.

I will have adequate facilities at my residence that will protect my new pet from the elements and provide a space that will allow him/her to freely move about and not be required to lie, sit or stand in his or her own excrement.
I will provide all veterinary treatment that my new pet may require throughout his/her lifetime.

I will return him/her to South Bend Animal Resource Center if I am unable to properly care for my new pet.

I will not to sell, give away or abandon my new pet without first contacting South Bend Animal Resource Center

I will not mistreat, abuse, fight or use my pet for experimental or medical research purposes OR allow anyone else to do so.

I will allow South Bend Animal Resource Center to review my home at any reasonable time and to remove my pet if the home is unsuitable or if it is officers determined that my pet is being neglected or mistreated in any way.
I will pay all reasonable costs, including court costs and attorney fees, incurred by South Bend Animal Resource Center in enforcing this contract if I fail to comply with its terms.
I understand that South Bend Animal Resource Center makes no representations or guarantees about any animal's temperament or health and that a pet’s behavior may change after it leaves the shelter and accustoms itself to a new home.

I understand that The City of South Bend will not be liable for any future injury or damage which may be caused by my new pet.

I understand that The City of South Bend makes every effort to adopt only healthy animals but makes no guarantees or representations about any animal's health and will not be liable for any future veterinary care or treatment the animal may need.

I understand that South Bend Animal Resource Center will be contacting my veterinarian for vaccination and health histories for any pets that I have owned and authorize him/her to release that information to SBARC. I am also aware that if my current pets are not up-to-date, the adoption may be delayed until they are vaccinated and acquire the immunity provided by the vaccines. Please be considerate of any delays we are only trying to ensure that our pets are placed in the best possible homes.

South Bend Animal Resource Center reserves the right to deny an application for any reason(s). These reasons may include but will not be limited to:
misinformation given on this application, unvaccinated pets, inadequate facilities, past record of nuisance pets, recommendation of veterinarian or other animal welfare organization, history of animal abuse or neglect, or already at the maximum number of pets.
I HAVE READ AND AGREE TO THE ABOVE*

I AGREE
By typing my name in the boxes below, I agree that I am electronically signing this form. I affirm that the information I've provided is accurate and true to the best of my knowledge. I understand that my electronic signature is legally binding and equivalent to my handwritten signature.
Signature*

First NameLast Name
Date

MonthDayYear
Date
Hour MinutesAM/PM Option
Should be Empty:

Pet Adoption Application

Household Information

People in the Household

Pet Ownership Information

Veterinarian Information

Submit Application