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2. 
3. Adoption Interest Questionnaire
   Thank you for choosing to adopt a pet from Placer County Animal Services! This questionnaire will help guide additional conversation with you to ensure that this pet is the right fit for you and your family. We will spend some time discussing the adoption process during a meet and greet with the pet you are interested in. If you are applying to adopt a dog, please be aware that all dogs four months of age or older are required to be licensed.
5. Animal Name or ID you are interested in*
6. Are you 18 years old or older?*

   1. Yes
   2. No
8. First Name*
9. Last Name*
11. Best Contact Phone Number*
12. Email Address*
14. Physical Address*
    We welcome adopters who rent, or live in an apartment or condo. We want to alert you that some landlords and management companies have size and breed restrictions, limits on number of pets, and/or require pet deposits or additional fees.
16. City*
17. State*
18. Zip Code*
20. Mailing Address (If different than Home Address above)
22. City
23. State
24. Zip Code
26. How many adults are there in your household?*
27. How many children are there in your household and their ages?*
28. Tell us about pets at home (select all that apply)*

    1. I have one or more dog(s)
    2. I have one or more cat(s)
    3. I have one or more small animal(s)
    4. I would like help with introducing a new pet to pet(s) at home
30. We’ll explain the pet's medical and behavioral history that we are aware of. Are there any additional topics you would like us to discuss with you?
32. Adoption Guidelines & Policies

    1. You must be over 18 years of age and show proof, if required.
    2. You must have a valid identification with your name and address, such as a driver's license, vehicle registration or CA identification card.
    3. While we provide veterinary care to our shelter pets, we cannot guarantee the health and temperament of any adopted animal.
    4. A reasonable means of confining must be provided. Chaining or tying as the sole means of confinement is not appropriate.
    5. All animals adopted from PCAS will be spayed/neutered in compliance with state/local laws before they are placed into a new home.
    6. Applicants with prior valid complaint(s) filed against them with Placer County Animal Services, may not be eligible to adopt an animal.
    7. Applicants suspected of being under the influence of alcohol or drugs, may not be able to adopt an animal.
    8. Placer County Animal Services reserves the right to refuse an animal adoption for any reason.
34. Things to Consider Before Adoption:

    1. Discuss your interest in pet adoption with others living in your home.
    2. If you rent or lease, landlords and rental agencies may have pet restrictions. Confirm these policies prior to adopting.
    3. Bring family members to the shelter to meet the pet you are interested in adopting.
    4. Consider all costs associated with caring for a pet such as food, licensing and vaccines.
    5. Caring for a pet requires an investment of your time.
    6. If you have other pets at home, please use our tips to introduce your new pet into the family.
    7. You are welcome to request a meet and greet to bring your dog/s to the shelter to meet the dog you are interested in adopting.
36. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
38. Electronic Signature*
    Check "I agree" box above, and then type your name in the Electronic Signature box as your signature.
39. Date*
    Date
Leave This Blank:


41. 1. Receive an email copy of this form.
42. Email address

    This field is not part of the form submission.

43. Submit Submit and Print

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