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Adoption Application

  1. Applicants for animal adoption must be at least 21 years of age.

  2. Please have identification ready to show proof of current address.

  3. Primary Adopter (Adult Responsible for this Pet)

  4. Housing

  5. Housing Situation*

  6. Check All that Apply*

  7. If living with Parents:

  8. Parent's Housing Situation

  9. If your current residence is rented, we must receive permission from the landlord. Permission from landlord must be received within 24 hours of submitting application.

  10. References

    Please provide two references, preferably not a family member, who we can contact.

  11. Are there children in your home?*

  12. Is anyone in the home allergic to animals?*

  13. Are you*

  14. Will this animal be kept (Outside means outside alone for more than 20 minutes)*

  15. During the Day

  16. At Night

  17. Which of the following best describes your reasons for wanting this dog / cat?*

    Check All that Apply

  18. Are you familiar with your local animal ordinances?*

  19. It may take an animal two weeks to a month or more to adjust to its new home. Are you prepared to give your new pet time and help it adjust to your family?*

  20. Have you considered the daily expenses for maintaining an animal? (Medical, Food, Grooming, etc.)*

  21. Are you familiar with humane and gentle procedures for housetraining?*

  22. If a behavior problem arises, are you prepared to invest the time and expense for training?*

  23. Do you understand that the City of Springdale Animal Services makes no representations or guarantees about any animal's temperament and that any comment that an animal may be good with children or other animals or is housebroken is based upon information provided by previous owners and not a guarantee?*

  24. Do you understand and agree that City of Springdale Animal Services and its Animal Shelter will not be liable for any future injury or damage that may be caused by this animal?*

  25. Do you understand that City of Springdale Animal Services and its Animal Shelter makes every effort to adopt only healthy animals but makes no guarantees or representations about any animal's health and will not be liable for any future veterinary care or treatment the animal may need? Animals adopted 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 animals have endured before arriving at the shelter.*

  26. Please list all pets currently at home and any that you have owned in the past 5 years.

  27. Gender

  28. Pet Type

  29. Spayed / Neutered

  30. Is (was) the pet kept inside or outside?

  31. Gender

  32. Pet Type

  33. Spayed / Neutered

  34. Is (was) the pet kept inside or outside?

  35. Gender

  36. Pet Type

  37. Spayed / Neutered

  38. Is (was) the pet kept inside or outside?

  39. Gender

  40. Pet Type

  41. Spayed / Neutered

  42. Is (was) the pet kept inside or outside?

  43. For pets listed above:

  44. Do you have a regular veterinarian or clinic?*

  45. Springdale
    Animal Services

    321 Randall Wobbe Lane
    Springdale, AR 72764
    Phone: 479-750-8166
    Fax: 479-750-8508

  46. 1. Applicants for animal adoption must be at least 21 years of age.
    2. Explain beside any question not answered why it isn't answered.
    3. Applicant must agree to abide by all the city animal ordinances.
    4. All dogs and cats three months and older are required to be spayed or neutered before the animal goes home with adopter. For animals under the age of three months adopter will pre-pay spay / neuter fee and will be given a voucher to have surgery done when animal is old enough. Spay/neuter must be done by the date on voucher.
    5. Applicants with young children will be evaluated based on the compatibility between the child and animal, which will be evaluated by Animal Shelter staff prior to adoption.
    6. If for any reason the adoption is not successful or the owner cannot keep the pet, we can take your pet back with a surrender appointment. Our appointments can run between 2 - 8 weeks ahead. You must make a surrender appointment to bring your pet back.
    7. Animals are placed as companion animals, not as guard dogs and typically not as mousers. We prefer strongly that your new pet will be kept inside your house and made a part of the family.
    8. If applicant owns other animals, they must be current on vaccinations, including rabies vaccination which must be done by a licensed veterinarian.
    9. Animals are generally not adopted to applicants having a history of ordinance violations, losing, giving away, selling animals or having animals injured or killed by moving vehicles.
    10. Verifiable and secure photo identification is required at the time of application and adoption.
    11. An animal will not be adopted to applicants providing false information on the adoption application.

  47. I agree to the above requirements and wish to adopt a pet.

  48. 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.

  49. Leave This Blank:

  50. This field is not part of the form submission.