SPCA of Westchester, Inc.

590 North State Road, Briarcliff Manor, NY 10510

(914) 941-2896 Fax (914)762-8312

Open Monday-Saturday 10am to 4pm; Sunday 1pm to 4pm

Canine Adoption Questionnaire:

In order to be considered for an adoption today, you must:

  1. Be at least 21 years of age
  2. Have legal identification with you current address
  3. Be able to verify that you are allowed to have a pet where you live
  4. Must provide vet and/or personal references
  5. Be able/willing to spend the time & money necessary to provide the training, medical treatment and proper care for the pet
  6. Understand that the SPCA of Westchester reserves the right to deny the adoption of any pet for anyreason

Fees to Adopt:

-Dogs – 1 year and Older: $200 to $350

-All Puppies – Under 1 year OR Dogs rescued from a High Kill Shelter/Southern Rescues: $350

-Lonely Hearts Club/Senior Dogs: $75

The SPCA of Westchester allows same day adoptions for most animals. No appointment is necessary to come in and adopt, unless noted otherwise on the SPCA’s Petfinder page. Please note, we do not hold animals or accept deposits for animals, even if your questionnaire is approved in advance.

**If you currently have a dog(s) at home, they MUST meet the dog you are interested in adopting from our shelter to ensure they get along before the adoption. Some dogs require ALL family members to be present at the time of adoption.**

Today’s Date:______Dog(s) interested in:______

Name:______E-Mail Address:______

Date of Birth:______Home Phone #:______

Address:______Alternate Phone #:______

City:______State:______Zip Code:______# of years at current address:______Do you currently live with a parent(s)? Y N Parent’s Name:______Phone #______

Do you Own or Rent a: HouseApartmentTownhouseCondo/Co-opOther:______

**If you Rent or own a condo/co-op, you will be required to provide a copy of your lease/bi-laws that states you can own a pet. Otherwise, you are required to provide us with the phone number of your landlord/management company.

Landlord’s Name/Management Company:______Phone #:______

Are you currently employed? Yes No Name of Employer: ______

If you are not employed, how do you plan to provide for the dog?______

**The minimum costs a dog owner will incur annually for a healthy dog is estimated between $500-$900. Are you prepared to cover these costs?______

  1. Why do you want to adopt a dog? (Please circle all that apply)

Companionship for meCompanion for my petExercise for MyselfCompanionship for my children Gift Other: ______

  1. Have you ever adopted from the SPCA of Westchester before? Yes No If yes, when?______
  2. How did you hear about us?______
  3. Does anyone in the household have allergies to dogs?______
  4. How long do you plan to provide a home for this dog?______
  5. Have you ever returned or re-homed a pet? Yes No If yes, why?______
  6. Who will be primarily responsible for this dog?______
  7. Who will take care of the dog in your absence (i.e. vacation, emergencies)?______
  8. Have you ever owned a dog before? Yes No

A. If yes, do you still have the dog? Yes No If not, explain______

**If you have a dog(s) at home, he/she must be present at the SPCA to meet any potential dog you are interested in.**

B. If your pet has since passed away, how long ago did you own a pet?______Pet’s Name______

  1. Please list names, ages and breeds of all pets you currently own:______

______

  1. Please list name, ages and relation of all children in the household:______

______

  1. Please list names, relation and contact numbers for all adults in the household:______

______

**The SPCA will call ALL adults in the household to ensure they approve of the dog(s) in question, prior to adoption**

  1. If there are no children living with you, are there children who visit your home? Yes No

If yes, who and how often?______

  1. What age/size dog are you interested in? (Please circle all that apply)

PuppyAdolescentAdultSenior

(3-5months) (5mo-2yrs) (2-7yrs)(8+yrs)

SmallMediumLargeX-LargeDepends on the dog

(15lbs of less) (20-45lbs) (50-75lbs) (80-100lbs.+)

  1. What type of daily exercise will your dog get?

Backyard playLeash walksOff-leash runsDog parksFetchHikingSwimming

  1. What qualities are most important to you in a dog? (Please circle all that apply)

Easygoing/Easy to train Loves other dogsProtective of me & my propertyEnergetic/ready to go

Quiet, doesn’t bark a lot Mellow/not hyperAlready knows sit, down, stay

  1. What times of day will your dog be alone?______How long? ______
  2. Do you have a fenced in yard? Yes NoHow high?______Type?______
  3. Where will dog be when you are not home?

Free to roam houseConfined to roomIn the garageIn a crateOutside

Doggy daycare/Pet sitterOther:______

If you currently, or within the past 2 years have owned a pet you need to provide veterinarian information:

Name of Vet:______

City:______Phone #:______

If you do not have a Vet, please provide a Personal Reference. This should either be a work reference or a friend, NOT a family member or person you live with.

Name:______How do you know this person?______

Phone #:______