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2. 
4. ATTENTION: BY FILLING OUT THIS APPLICATION, YOU ARE NOT GUARANTEED A SPECIFIC ANIMAL.
6. The animals adopted from the Davidson County Animal Shelter may have been exposed to various diseases from proximity to other animals. In addition, the physical condition of some animals may be less than ideal due to conditions the animal may have endured before arriving at the shelter; consequently, there is some risk in adoption. The DCAS strives to carefully screen animals and to inform prospective adopters of any perceivable problems, however, some problems may not be evident to the DCAS at the time of adoption. Please understand that after adopting an animal from DCAS it is your responsibility to have it checked by your regular veterinarian within 5 days. The Davidson County Animal Shelter is legally not allowed to treat any sickness or disease after adoption, since we are not a licensed animal hospital.
10. Date*
    Date
11. What are you interested in?*

    1. Cat
    2. Dog
    3. Other
15. Contact Information:
17. Full Name*
19. Address*
21. City*
22. State*
23. Zip Code*
25. Phone Number*
26. Home or Work Number
28. Email Address*
30. Full name of emergency contact for animal*
    (Other than yourself)
31. Phone*
35. Your Home:
37. Do you...?*

    1. Own
    2. Rent
    3. Rent to Own
    4. Live With Parents
    5. Live In Military Housing
39. Housing style (check all that apply)*

    1. House
    2. Apartment
    3. Mobile Home
    4. Condo/Townhouse
    5. College Dorm
41. Name of landlord / parent / apartment*
42. Phone of landlord / parent / apartment*
44. My in-home family consists of:
46. Adults*
47. Children*
48. Age of children
50. My new pet will be kept:*

    1. Inside
    2. Outside
    3. Both
52. My yard is*

    1. Fenced in
    2. Not fenced in
54. If there is no fence, how do you plan to keep your new pet contained?*

    1. Invisible fence
    2. Dog lot
    3. Chain
    4. Zipline/Cable
    5. Leash
    6. Other
56. If other, please explain:*
58. Tell us a little about your family, your lifestyle, and what you are looking for in a new pet.
60. Have you owned pets in the past? *

    1. Yes
    2. No
64. Current Pets:
66. Do you currently own any pets?*

    1. Yes
    2. No
68. Name of animal*
69. Breed*
70. Sex*

    1. Male
    2. Female
    3. Spayed Female
    4. Neutered Male
71. Where is the animal kept?*

    1. Inside
    2. Outside
    3. Both
73. Do you have another pet?*
    -- Select One --YesNo
75. Name of animal*
76. Breed*
77. Sex*

    1. Male
    2. Female
    3. Spayed Female
    4. Neutered Male
78. Where is the animal kept?*

    1. Inside
    2. Outside
    3. Both
80. Do you have another pet?*
    -- Select One --YesNo
82. Name of animal*
83. Breed*
84. Sex*

    1. Male
    2. Female
    3. Spayed Female
    4. Neutered Male
85. Where is the animal kept?*

    1. Inside
    2. Outside
    3. Both
87. Do you have another pet?*
    -- Select One --YesNo
89. Name of animal*
90. Breed*
91. Sex*

    1. Male
    2. Female
    3. Spayed Female
    4. Neutered Male
92. Where is the animal kept?*

    1. Inside
    2. Outside
    3. Both
94. Do you have another pet?*
    -- Select One --YesNo
96. Name of animal*
97. Breed*
98. Sex*

    1. Male
    2. Female
    3. Spayed Female
    4. Neutered Male
99. Where is the animal kept?*

    1. Inside
    2. Outside
    3. Both
101. Do you have another pet?*
     -- Select One --YesNo
103. Name of animal*
104. Breed*
105. Sex*

     1. Male
     2. Female
     3. Spayed Female
     4. Neutered Male
106. Where is the animal kept?*

     1. Inside
     2. Outside
     3. Both
108. Do you have another pet?*
     -- Select One --YesNo
110. Name of animal*
111. Breed*
112. Sex*

     1. Male
     2. Female
     3. Spayed Female
     4. Neutered Male
113. Where is the animal kept?*

     1. Inside
     2. Outside
     3. Both
115. Do you have another pet?*
     -- Select One --YesNo
117. Name of animal*
118. Breed*
119. Sex*

     1. Male
     2. Female
     3. Spayed Female
     4. Neutered Male
120. Where is the animal kept?*

     1. Inside
     2. Outside
     3. Both
122. Do you have another pet?*
     -- Select One --YesNo
124. If yes, please list any other pets. Provide Name, Breed, Sex, Spayed or Neutered, and Where the animal is kept.*
126. Name and number of your current veterinarian.*
128. Veterinary record owner:*
     Please specify whose name your current pet's veterinary records are under if not under your name.
130. Do you have the financial resources to care and provide for this animal?*

     1. Yes
     2. No
132. Have you ever been convicted of animal cruelty or any crime involving animals?*

     1. Yes
     2. No
136. Adoption guidelines:
138. 1. A valid photo ID is required for all adoptions. Must be 18 or older.
140. 2. Written or oral landlord approval is required for all adopters residing in a rental property.
142. 3. All animals adopted will be given age appropriate vaccines and a microchip before leaving the shelter.
144. 4. Any adoption may be approved or refused by a staff member.
146. 5. No adoptions will be made to people known to hoard/collect animals, to individuals who are threatening, who appear to be under the influence of drugs or alcohol, who have been convicted of animal cruelty, or who appear to have impaired judgment.
148. 6. All pets over the age of 4 months in the adoptee’s home must be current on rabies vaccinations as required by North Carolina State Law.
150. 7. Animals will not be adopted to homes where they will be placed on chains or zip lines.
152. 8. Any individual who has previously surrendered a pet to an animal shelter may not be eligible to adopt an animal.
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154. 1. Receive an email copy of this form.
155. Email address

     This field is not part of the form submission.

156. Submit

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