Company Date * I wish to adopt from the following location: * Antigonish Cape Breton Colchester Dartmouth Hants Kings La Baie Lunenburg Pictou Queens Yarmouth HRM Animal Redemption Centre I am submitting this application because... * I am ready to adopt now Name of the dog I would like to adopt is: * *Please note - We do not accept preapproval applications or wait lists. Please do not submit your application with a generic description such as 'puppy' or 'small dog' without indicating the name of the dog that is currently listed for adoption. First Name * Last Name * Address * Address Line 2 City * Postal Code Province * Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Phone * Email * Please list the name of someone who is your emergency contact for the microchip registration file. They will be added as a back up to your microchip contacts in addition to any contact numbers listed above, this should not be someone who lives in the home with you. Phone number for emergency contact Please add me to your free e-newsletter for warm fuzzies * Yes No Number of adults in my home * Name of all adults in my home: * Please include last names if it differs from the last name of applicant. Number of children in my home * Ages of children in my home Please list ages of each child in the home Do you have any children who regularly visit? If yes, please note their ages I have the following pet(s) in my home: Dog Cat Other Dog #1 Name Please fill the above information for EACH dog(s) in your household Age Breed Sex (M/F) Fixed? Yes No Dog #2 Name Please fill the above information for EACH dog(s) in your household Age Breed Sex (M/F) Fixed? Yes No Dog #3 Name Please fill the above information for EACH dog(s) in your household Age Breed Sex (M/F) Fixed? Yes No Dog #4 Name Please fill the above information for EACH dog(s) in your household Age Breed Sex (M/F) Fixed? Yes No My experience with dogs... * I am a first time dog owner I am an experienced dog owner My new dog will be kept... * Primarily Indoors Indoors and Outdoors Outdoors Only My new dog will be left home alone for this many hours each day * I would like to include my dog in the following activities (e.g. Hiking) * Let us know what you're looking for in a puppy or dog so we can find you a perfect match... * Puppy Young Adult Adult Senior No Preference The ideal size (as an adult) would be: * Extra small (less that 15 lbs) Small (15-25 lbs) Medium (25-50 lbs) Large (50-75 lbs) Extra Large (75+lbs) Gender * Male Female No Preference Energy Level * Low Medium High No prefernce Coat (Hair) Length * Short Medium Long No Preference I would prefer the following breeds and/or breed mixes: Things I would like to know more about: * Supplies I will need to get started Introducing the new dog to my current pets Introducing the new dog to my children House training Training techniques Dog trainers and obedience classes in my area Annual veterinary care requirements and costs Veterinarians in my area Dealing with unwanted behaviors Food and nutrition Other The Nova Scotia SPCA can provide you with information on a variety of animal care and behavioral issues. Let us know if there is anything you'd like to learn about! Reference #1 First Name * Last Name * Relationship * Friend Family Member Co-Worker or Boss Veterinarian Other Contact Number * Alternate Contact Number Reference #2 First Name * Last Name * Relationship * Friend Family Member Co-Worker or Boss Veterinarian Other Contact Number * Alternate Contact Number Reference #3 First Name * Last Name * Relationship * Friend Family Member Co-Worker or Boss Veterinarian Other Contact Number * Alternate Contact Number *Only one of your references can be a family member Consent - I hereby verify that all information provided in this form is truthful and correct. I also permit The Nova Scotia SPCA to contact my references with the information I've provided. * Yes
