Adoption ApplicationEmployment ApplicationVolunteer ApplicaitonLost ReportAssistance ApplicationsAdoption Application Adoption Application To ensure your application is properly submitted, please read the following:*Make sure to answer ALL questions on the application. If a question does not apply to you, please enter "0" or "NA"! You will be taken to a confirmation page after your application has been successfully submitted!Adoption FeesDog- Altered- $155 Dog- Unaltered- $55 (plus surgery cost) Cat- Altered- $100 Cat- Unaltered- $40 (plus surgery cost)Identify what animal you are looking to adopt.*If not animal specific, please type 'none"Part 1- Personal InformationName* First Last Spouse's Name First Last Date Time* : HH MM AM PM Phone*Physical Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Are you a veteran? Yes No Are you over 62? Yes No Employeer*Occupation*Spouse's EmployeerSpouse's OccupationDo you own your own home?*YesNoDo you own the land your home is on?*YesNoIf no to either, Landlord's Name First Last Landlord's NumberAre you over the age of 18?*YesNoDo you plan to move in the next 6 months?*YesNoPart 2- Prior/Current Pet InformationList all pets that are currently in your home or visit frequently.*Include: name, species, breed, age and sex. Are they currently all spayed/neutered* Yes No Are they currently up to date on their vaccination* Yes No Have you ever surrendered an animal to the shelter?* Yes No List of the pets you have previously owned, in the last 10 years.*Include: reason why you no longer have the animal. Veterinarian*Phone Number of Veterinarian's Office*Part 3-General InquiresDo you have any children in your home?* Yes No If yes, what are their ages?*Please list any additional people that reside with you for an extended period of time.On average, how long will the pet be alone during the day?*Part 4-Dog Specific QuestionsComplete these questions only if interested in a dog. How is the dog going to be contained to your property?Have you owned a dog in the past? Yes No Have you adopted a dog from a shelter in the past? Yes No How do you plan to deal with behavioral issues if they arise?Are you familiar with crate training? Yes No Are you familiar with house breaking? Yes No Is this going to be an indoor or outdoor dog? Indoor Outdoor Both Are you familiar with grooming needs? Yes No Part 5-Cat Specific QuestionsFill out if interested in adopting a cat. Is this going to be an indoor or outdoor cat? Indoor Outdoor Both Do you plan on declawing? Yes No Have you adopted a cat from a shelter in the past? Yes No Are you familiar with grooming needs? Yes No Part 6-Personal References ( NON FAMILY)List 2 non-family personal references.Name* First Last First ReferencePhone*First referenceRelationship*Name* First Last Second ReferencePhone*Second ReferenceRelationship*Second ReferenceMUST READI certify that the above information is accurate and complete to the best of my knowledge. I understand that the CSPCA has the right to reclaim the animal if any given information is found to be false. I authorize the release of veterinarian information related to my current and past pets. I understand that there are costs associated with owning a pet, that the costs can range from $400-$800 annually and that there may also be additional cost due to injury or illnessOnline Signature*Please type your full name confirming that you have read and understand the above statement. Look for our Confirmation Page to ensure your application was submitted to us!You will be redirected to a confirmation page!EmailThis field is for validation purposes and should be left unchanged. Employment Application Employment Date Name* Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Email* Are you over the age of 18?*YesNoAre you legally able to work in this country?*YesNoHave you ever been convicted of a felony?*YesNoIf yes, please explainPosition Desired*Kennel AttendantCustomer ServiceAdministrativeOtherDate you can start*Salary Desired*Are you currently employed?*YesNoIf so, where are you currently employed?Have you ever applied to the Chenango SPCA before?*YesNoIf so, when?Referred by:Education Completed* High School GED Some College College Degree Summarize Work Experience*Special Job SkillsWhich of your past jobs did you enjoy the most and why?*Reference 1 First Last Relationship*Years acquainted*PhoneReference 2* First Last Relationship*Years acquainted*PhoneReference 3 First Last Relationship*Years acquainted*PhoneYour Inquiry Message*Attach Resume Volunteer Applicaiton Volunteer Date* Name* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Phone*Email* Enter Email Confirm Email Age*EmployerEducation HistorySchoolGradeExpected Date of GraduationCommunity ServiceIs this for Community Service?*YesNoEmergency ContactName* First Last Relationship*Phone*Please tell us about any experience you have had working directly with animals:Please check any volunteer jobs that you are interested in:*General CleaningDog WalkerDigital PhotographyCat and Dog GroomingMaintenanceCat SocializationOutreach/EducationIndicate what days and times you are available.* Monday- 7:30 am-11:00 am Tuesday- 7:30 am-11:00 am Tuesdays- noon-4:00 pm Wednesday- 7:30 am-11:00 am Wednesday- noon-4:00 pm Thursday- 7:30 am-11:00 am Friday- 7:30 am-11:00 am Friday- noon-4:00 pm Saturday- 7:30 am-11:00 am Sunday- 7:30 am-11:00 am Lost Report Lost Pet Have you recently lost your pet? Please complete this form Lost Reports will be held for 60 days. Pets Name*Type of PetDogCatBreedGenderMaleFemaleUnknownSpayed/Neutered?YesNoAge*Approx. WeightColor/Markings*Be as detailed as possible.Last Seen* Owner Name* First Last Owner Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country PhoneEmail* Any other Notes about AnimalUpload PhotoAdding a photo is very helpful with identifying the animal. Assistance Applications Printable SNOOP Application Printable Kerby Flea and Full Bellies application
| Copyright 2014 © CSPCA