Madera County Animal Shelter Adoption Application

Type of pet desired
Reason for wanting this pet    Companion    Gift       Other
Your Name DL#
Address
City         State           Zip 
Home Phone         Work Phone 
Employer         Occupation 
Email

Type of dwelling

Own House    Rent House    Rent Apartment
Other*
             * An example of "Other" would be living with parents.
If you rent, what is your landlord's name?  
Number of adults in household           Number of children in household 
Ages of children in household 
Does anyone have any allergies to animals?       Yes        No
Who is your veterinarian?     City 
Have you ever owned a pet before?       Yes        No
Do you currently own any pets now?       Yes        No
If you answered yes, please complete the following:
Species Sex Spayed/Neutered Age How long owned? Where Kept?
Are your animals vaccinated and licensed in the city or county where you reside?
Yes      No
If not, why not?  
Who will ultimately be responsible for the animal? 
Do you have a securely fenced yard?      Yes        No
Where will the animal spend the majority of its time?       Indoors        Outdoors
If outdoors, what do you have available to protect the pet from the weather? 
How will you accomplish obedience training for your new pet?  
List characteristics desired in your new pet 
I UNDERSTAND THAT MADERA COUNTY ANIMAL CONTROL HAS THE OBLIGATION TO VERIFY ALL INFORMATION ON THIS APPLICATION. INACCURATE INFORMATION COULD JEOPARDIZE THE ADOPTION PROCESS.

MADERA COUNTY ANIMAL CONTROL RESERVES THE RIGHT TO INSPECT THE PREMISES ON WHICH THE ANIMAL WILL BE RESIDING.
Signature        Date 
Remarks by adoption counselor  
Approved        Not Approved
Reason         Counselor 

 
Please click on the submit button to send this form by email or print and mail to:
Madera County Department of Animal Control
14269 Road 28
Madera, CA 93638
Telephone (559) 675-7891
TeleFax (559) 675-7617