name of animal you're
interested in adopting:
today's date m/d/year:
Personal Information
are you over the age of 18?:
your full name:
email address:
street address:
day/work phone:
home/evening phone:
place of employment
occupation (you):
place of employment
(spouse, if applicable):
occupation (spouse):
VET & Personal References
Provide the contact information of a veterinarian you have used
before and/or plan to use with your new dog/cat? Vet and Personal
references will be checked by shelter manager.
1 Vet name/phone:
2 Vet name/phone:
1 Personal name/phone:
2 Personal name/phone:
Household Information
What type of residence do you have?
Do you rent or own?
If you rent, you must provide the name and phone number
of your landlord so that we may confirm that you are
permitted to have pets:
List the names, ages, and relation of all persons who currently
live at this residence:
Do any residents of this house of
known allergies to cats or dogs?
If yes, please explain:
Pet History
List information for any pets currently residing in household,
breed, sex, age, neutered/spayed, how long owned, kept
Have you owned any other pets?
If yes, provide the following
information for each pet:

name of pet
where is the animal now?
year of death (if decesased)
cause of death (if deceased)
Have any of your pets ever had puppies or kittens?
Care of the Animal
Do you have a fenced in yard? if so, please describe
type of fence & yard:
If you do not have a fence, please tell us how you plan to
let the animal relieve itself:
Do all adults work full time?
How many hours per day will
your pet be home alone?
Where will your new pet
Where will your new pet
spend the majority of it's time:
What sort of training to you
plan to provide for your new
Where will your new pet be
kept when it is alone?
Have you ever taken one of
your pets to a shelter?
(if so,
please describe the circumstances)
Please describe your home &
(ex. single family home on
well traveled street with a small
front yard)
Additional Info
We request an adoption fee donation. The cost varies depending on
several factors. The money supports the operation of our shelter,
including daily care, vet care and rescue. Is this acceptable?
Please realize that dogs can live to 15 years of age, cats up to 20
years of age, and other animals vary. Your pet will need vet care
throughout it's live, including yearly boosters, heartworm and
flea/tick preventive meds, etc.  Are you financially able to provide
professional veterinary care for the foreseeable lifetime of the
Please list any additional comments you would like to add:
How did you first learn about this animal?
Please sign me up for Animail so I can receive the shelter
newsletter, news and event updates via email.
email address:
*By clicking the Submit button below I agree to the terms and
conditions of the shelter. I have read the Adoption Tips. I certify the
above information is accurate and complete to the best of my
knowledge. I authorize the release of veterinarian information
related to my past and current pets. I give the SC-SPCA permission
to contact the persons listed above for a character reference. Any
incomplete or inaccurate info will be grounds for application denial.
Copyright © 2012 - Sullivan County SPCA, founded 1907
PO Box 995 - Rock Hill, NY 12775 - (845) 796-3120
Sullivan County
PO Box 995
Rock Hill, NY
(845) 796-3120

Get shelter
Hours &

Fax 845-794-2254 or mail: SC-SPCA Manager, PO Box 995, Rock Hill, NY 12775
Important: Read the ADOPTION TIPS before submitting your application. If
you find an animal you are interested in adopting, we encourage you to
complete an adoption application in advance. Apply online,
download and
print or obtain an application at our front desk.