Name
*
First Name
Last Name
Home Phone
*
Cell Phone
*
Email
*
Street Address
*
City
*
State
*
Zip Code
*
Are you 21 and over?
*
Employment
*
Work Phone
*
Would you like to receive email updates?
*
How did you hear about the APCSM?
*
Housing
*
Own
Rent
Live with parents
Type of Housing
*
How long have you lived at this residence?
*
Landlord's Phone Number
Please list the ages of all members in the household, including the primary adopter
*
Who will be the primary caretaker of your pet?
*
Does anyone in your household have allergies to animals?
*
Yes
No
If yes, which types?
Please list animals you have owned in the past 5 years.
*
Please include name, type of animal, breed, age, sex (spayed/neutered), still own (if no, please explain).
Your Veterinarian
*
Veterinarian's Phone Number
*
Please call your vet and give them the "ok" to release medical history to shelters. Are your vet records already released?
*
If your vet has permanently closed, please bring all medical paperwork with you to your surrender appointment.
If the specific small animal you are interested in has already been adopted, are you interested in us contacting you regarding any other animals?
*
Sometimes, we receive multiple applications for one animal. By selecting "No," a staff member will NOT contact you regarding our other available animals.
Please tell us why you would like to adopt a pet.
*
What type of small are you looking for?
*
Breed, M/F, energy level, etc.
Your adoption counselor will provide detailed information about caring for your pet. Do you have any specific questions or concerns?
*
By typing your name below, I certify that the information I have given is true and that I recognize that any misrepresentation of facts may result in my losing the privilege of adopting a pet. I understand that the Animal Protection Center of Southeastern Massachusetts has the right to deny my request to adopt an animal, and I authorize investigation of all statements on this application.
*
Thank you for your interest in adopting. Your application has been submitted to our team. Please keep in mind, we receive a high volume of applications, and submitting an application does not guarantee an adoption. If you are a match for one of our available animals, we will be in contact soon. If you do not hear back from our staff within 48 hours, the animal in question has been adopted or your application was not chosen as a match. If you have any questions, please email us at info@apcsm.org. Thank you for your cooperation!
