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Small Animal Adoption Application

Date

First name*

Last name*

Animal of interest*

Birthday

Physical Address*

Town*

State*

Zip Code*

Mailing address (if different than physical)*

Email*

Cell phone*

Home phone

Place of employment / Job title*

Household Information:

Name of spouse/partner (if applicable)

Number of adults in your home*

number of children in your home*

Ages of children in your home

What type of home do you reside in?*

House

Apartment

Mobile Home (on owned land)

Mobile Home (in privately owned park)

Condo

Other

Do you:*

Own

Rent

Live with owner

Live with parent or guardian

Other

Name of Landlord/homeowner (Use N/A if you own)*

Phone or email of landlord/homeowner (Use N/A if you own)*

How long have you lived at your current residence

Please list the address of the last place you resided and for how long*

Veterinarian Information:

You must contact your veterinarian to give permission to speak with us for a reference. Please check box

Name and Number of your veterinarian*

How many pets are currently in your home?*

Please list ALL current and past pets within the last 5 years (please include name, species, gender, age and if they are still with you or not)*

Animal Information:

What type of small pet are you interested in adopting (check all that apply)*

Rabbit

Guinea Pig

Hamster

Ferret

Other

Gender *

Male

Female

Open to gender

Please describe your experience with the type of pet you are interested in adopting.*

How do you plan to house the small animal you are interested in adopting?*

Have you considered what you would do with this pet if you had to move? What would that be?*

Have you considered what you would do with this pet if you were unable to care for it due to personal injury, illness or death? Do you have a person who will take care of your pet and if so, have you confirmed this with them?*

Please list TWO personal references that are not family or a spouse. (please give name and phone or email to contact)*

Contact

Phone

802-885-3997

Email

spfldhumane@vermontel.net

Location

401 Skitchewaug Trail, Springfield, VT 05156

Area of Service

Andover, Baltimore, Cavendish, Chester, Grafton, Londonderry, Ludlow, Springfield,
Weathersfield, Weston and Windsor

Hours of Operation

Wednesday - Saturday

12pm-4pm

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