Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Animal Name/ID Number or the type size dog you might be interested in. We will keep your application on file.Name *FirstLastEmail *Current Street Address *Current City Address *Curent State address and zip code *Current township *Date of Birth *Drivers License # and State Issued *Primary Phone *Are you at least 18 yearsof age? *YesNoAre you currently employed or retired? *yes employedyes retirednot employed or retiredIf employed name of employerWhy do you want a dog? *List all Family members in household (with ages)Do you or any of your family members have any animal allergies?YesNoList all pets in household ie,dog,cat or other include male or female and if the animal is spay/neutered Are they up to date on all vaccines? Answer for each pet..Will you license your dog? *YesNoHave you ever relinquished a dog if so when and please explain. *Are you aware of dog control laws? *YesNoWhich best describes where you liveHouseApartmentIs where you live City or Rural *CityRuralDo you own or rent your home? *If you rent give the landlords name and a good contact number.How many hours will this dog be home alone? *Where will the dog be when you are not at home? *What best describes your household? Quiet, Noisy, Active or Average? Answer belowWhat Veterinary hospital that will be used for your new pet?Please read through and type your initials next to each of the following statement,Will you keep this dog in your home? Please say yes or no and initial. *I understand that Southern Tier Animal Control Inc. makes no representations whatsoever relating to the health, habits or any other fact about the dog. *I understand that my pet may have an illness that is not immediately apparent and Southern Tier Animal Control Inc, is not responsible for veterinary care should the dog have an illness. *I understand that there is a risk that my current family pet could b exposed to illness and Southern Tier Animal Control Inc. is not responsible for their veterinary care should they become ill. *I understand that it is recommended that my new pet be isolated from my current family pets until it has seen my veterinarian. *I agree to call within 5 days of the adoption to make an appointment to take my new pet to my veterinarian (wellness check and schedule spay/neuter appointment) *I understand that a pet needs to be seen by a veterinarian at least once a year for an annual physical, vaccinations and flea/heartworm preventatives. *I agree to have my pet spayed/neutered within 30 days after the adoption date to receive the $35 dollar deposit back. *When you sign you are signing to notify STAC if you have rehomed/or the dog is no longer in your care. You will furnish the information of where the dog is and information that allows STAC to contact the new owners. *I understand that New York State Law requires written permission before releasing my new animal's medical information to anyone but me. By initialing this form and signing the agreement below, I am allowing Southern Tier Animal Control Inc. to obtain all information concerning my animals from the veterinary hospital that i have provided on this application. *By typing your name below you are signing this document, I am accepting all of the risks associated with the handling of animal during the adoption process. I understand that this document will be retained on file by Southern Tier Animal Control Inc. I further attest that the information I have given is true and understand that giving any false or incomplete information may result in the application being denied. *Stop application here SHELTER INFO ONLY Date ReviewedHome VerifiedApproved or DeniedSubmit