Adoption Application

I, agree that all statements in this application are made based on personal knowledge and are made for purposes of my application to adopt one or more animals through Bibb County Animal Services (BCAS).

Animal I am interested in adopting:

(Name)

(ID number)

I understand that BCAS is very concerned about the security and safety of the animal I would like to adopt, as well as its ability to keep track of all animals adopted. I understand BCAS will not share this information for any reasons not connected to applicable lawsuits or legal reasons.

Name:

Address:

Email:

City:

State:

Zip:

Home Phone:

Cell Phone:

Work Phone:

Please tell us how to best get in touch with you (check one).

Phone

How did you hear about us?

Date of Birth:

Driver’s License/ID Number:

State:

Expiration date:

I own my home and am permitted to bring an animal or animals into my dwelling.

I rent my home and am permitted to bring an animal or animals into my dwelling.

Landlord’s Name:

Telephone:

Length of time at this residence:

Address:

City:

State:

Zip:

Your Dwelling Type:

House

Condo

Apartment

Townhouse

Do you plan to move within the next 6-12 months?

If you rent, are pets allowed?

Why do you want to adopt?

Companion for you/family/another pet

Guard Dog

Gift (for whom):

Other(Explain):

Do you have a fenced yard?

Yes. Height:

No.

Type:

Wood

Chain Link

Split Rail

Where my adopted animal will sleep at night:

Where my adopted animal will stay during the day when I am home:

Where my adopted animal will stay during the day when I am not home:

Name, address, and telephone number of my employer (or business, if self-employed):

Business Name

Telephone

Position

Length of time with this employer

Address

City

State

Zip

Details for Companion Animal

I Currently have animals (cats/dogs) residing on my property

Inside my home
Tethered outside length of tether,doghouse, or free standing kennel (describe)
Roaming free on property
Fenced Yard, Height of fence

Spayed/Neutered.

I have bred this animal in the past.

I am currently breeding this animal.

Do your current pets get along with other animals?

Yes

Not Applicable

Farm Animals:

I had elective surgery performed on this animal: cat declaw, ears clipped, tail docked, etc. please describe:

Where I got this animal:

Percentage of time he/she spends outside:

Where he/she sleeps at night:

Where he/she stays during the day when I am home:

Where he/she stays during the day when I am not home:

If no longer with you, what happened to him/her?

Vaccinations administered and when:

The name of the veterinarian(s) I use for my companion animals is (if more than one, please list all veterinarians consulted in the last 5 years;)

Name of specific vet I use

Clinic Name

Address

Phone Number:

City

State

Zip

Name of specific vet I will use for ADOPTED ANIMAL

Clinic Name

Address

Phone Number:

City

State

Zip

I have been a client of this vet for

Records are under the name of

May we contact this vet as a reference?

Yes

I have children in the house.

Ages:

List of all people living in the house and/or who have regular contact with my animal(s) and their relationship to me (include family, friends, domestic employees, etc.):

Name:

is my:

Name:

is my:

Name:

is my:

Name:

is my:

Name:

is my:

Name:

is my:

Name:

is my:

Does anyone living in your home have any known allergies?

Yes

Have your children ever been around dogs and/or cats?

Yes

Not Applicable

Has your child ever been bitten by a dog?

Yes

Not Applicable

List of two references – people who know me (but are NOT RELATED to me) and my companion animal(s) and have been to my home recently:

Name

Relation is my:

Phone Number

Name

Relation is my:

Phone Number

Which of the following situations would lead you to give away your pet?

Moving to another state

Fleas sheds too much

Having a baby

Finished school/ moving back home

Ruins the furniture

Children will no longer care for dog

Too expensive

Allergies

Getting a divorce or married

Found a new "no pet" rental

Grew too big

Digging/Chewing

Would not give up for any reason

Other

What would you do with your pet if you could not keep it for the reasons stated above?

Have you ever surrendered a pet to a shelter/pound?

Yes

If yes, why?

Do You have a relative who would adopt the pet if you, for any reason, become incapable of caring for him/her?

Yes

If yes, please provide their name, address phone number and relation:

Would you allow an inspection of your home and/or yard?

Yes

I understand an Animal Enforcement Officer may visit my home for a home inspection before my adoption application is approved.
I understand that if I am approved for adoption, I will also need to carefully read the Adoption Agreement. The Adoption Agreement represents the legal contract between the adopter and BCAS. I understand that if I am approved to adopt an animal, I must comply with all stipulations listed on the Adoption Agreement. This Agreement must be signed before the animal can be taken home.
I have read this Application in its entirety, and I agree that all statements contained in this document are made by me and are truthful. I make this statement under penalty of perjury under the laws of the state of Georgia.

Signature

Print Name

Date

Office of the Sheriff • Bibb County, Georgia

Sheriff David J. Davis

Bibb County Animal Services

4214 Fulton Mill Rd., Macon, Ga. 31216

(478) 621-6774

ADOPTION APPLICATION

Details for Companion Animal