The Stafford SPCA’s goal is to find permanent, loving, responsible homes for the animals in our care. We try to find a match that considers not only the best interests of the animal, but those of people as well. The Stafford SPCA reserves the right, without explanation, to refuse any application, and to deny any adoption in its absolute discretion. The following questionnaire must be completed in its entirety, and all references will be verified.

Please complete and submit the form below. Every field with a red asterisk (*) must be completed in order for the form to be submitted. If required fields are skipped or not completed, the form will not submit.

11. List all of the animals you have owned in the past two years. Include the name of the animal, type of animal, its sex, age, whether or not you still own it and if not, why.

I certify that all information contained in this application is true, and I understand that false information may void this application. I also certify that neither I, nor anyone in our household has ever been convicted of animal cruelty, neglect or abandonment. My electronic signature is binding and carries the same weight as my written signature.

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Authorization for Release of Medical Information

If you have owned an animal in the past two years, please sign below.

I have made application to the Stafford SPCA to adopt an animal. I hereby authorize the Stafford SPCA to contact any and all veterinarians, veterinary technicians, health care providers and any other individuals who have provided health and/or medical care to my current and/or past animals and I authorize any and all individuals so contacted to release any and all such information to the Stafford SPCA. My electronic signature is binding and carries the same weight as my written signature.

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References

REFERENCE 1

REFERENCE 2