ADOPTION APPLICATION

BOCES ANIMAL SCIENCE

435 Glenwood Road

Binghamton, New York 13905

Please complete and submit this application via any of the methods below:

·  Save a copy to your local computer, answer all questions and email the completed application back to:

o  and

o 

·  Or, print it, answer all questions and either mail the completed application to the address above or fax it to: 607-763-3654, ATTN: Animal Science

If you have questions, you may call us at 607-763-3359

The answers you give on this application will help us to find the best possible match between you and the dogs available through Broome-Tioga BOCES. (BOCES) Please fill out the complete form and return to Animal Science, Broome-Tioga BOCES, 435 Glenwood Rd, Binghamton, NY 13905

Please list all animals you are interested in:
Name: / Phone:
Address: / Work #:
City: / Zip:
Occupation:
Best time to call:
Personal reference: (cannot be a relative)
1.  Name: / Phone #:
2.  Name:
Do you own or rent your home? / o Own
o Rent – if you rent, please provide landlord’s name & phone number
Landlord’s name: / Landlord’s phone #:
How long have you lived at this address?
Do you have a fenced yard? / Type:
Does the fencing completely enclose the yard for the dog?
If no, how will you handle the dog’s exercise, toilet duties, daily walks and runs?
Do you have a separate kennel run? / Height & size:
If adopting a cat, where do you plan on keeping the litter box? ______
Do you agree to keep this cat(s) indoor only? Yes No
How many adults in the household? / How many children?
List ages of children:
Are there regular visitors to your home (human or animal), which your new dog must get along with?
Describe:
Do you own other dogs? / How many?
Please list all animals currently in the home below with their name, breed, age and sex (also spayed or neutered)
Have you ever obedience trained a dog?
Do you own any other pets? / What kind?
Who is your regular veterinarian? / Phone:
Other than the listed above, how many other animals have you owned in the last 5 years?
Provide breed, name and what happened to them:
List all plans for this dog/activities/purpose for owning the dog:
Where will the dog spend the day? (check which one applies)
o Loose indoors / o Crate / o Basement / o Garage
o Fenced yard / o Kennel run / o Loose outdoors / o Tied outside
Other (please describe):
How many hours on the average will the dog spend alone?
Do you agree with the BOCES policy that all dogs adopted through BOCES be spayed / neutered?
If not, please explain):
Do you agree to license the dog and provide regular veterinary health care?
Do you agree to contact BOCES if you can no longer keep this dog?
Would you be willing to let a representative of BOCES visit your home by appointment?
If no, please explain:
How did you hear about the BOCES Animal Science program?

All the above information that I have given is true and complete. Should an unneutered or unsprayed dog be placed with me, I agree to have it spayed/neutered within one month of adoption or by ______, which will be determined by the BOCES representative and agreed upon by the BOCES representative and me. This dog will reside in my home as a pet.

I understand that BOCES is a referral service and is not responsible for the accuracy of information received about the temperament, habits or physical condition of dogs available for adoption. I understand it is my responsibility to see and evaluate the dog for myself before agreeing to adopt it. I am in full agreement with these terms of the adoption.

I give my permission to verify any and all information provided on this application. I further understand that BOCES is in no way liable or responsible for any damage, accident or injury resulting from the placement of a dog into my household.

Applicant Signature: / Date:

(Applicant must be 18 years old or older)

BOCES RESERVES THE RIGHT TO REFUSE AN APPLICATION. Reasons for refusal will vary. Some of the reasons for refusal, but not limited to these reasons are:

·  No veterinary reference

·  No prior experience caring for or handling the type of animal being considered for adoption

·  Other pets not spayed/neutered

·  Other pets not up to date on vaccinations

·  No written rental agreement which allows pets

·  Pet chosen is unsuitable for adoption in the home although another pet might be approved

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