Adoption Application

Thank you for considering an animal from the Roanoke Valley Society for the Prevention of Cruelty to Animals (the “Roanoke Valley SPCA”) to be a new addition to your family! Our Adoption Counselors are here to help you. If you have any questions, please ask.

Animal Name*
Animal ID#*
The Roanoke Valley SPCA is a non-profit organization that relies on generous donors to support the care, feeding and shelter of the animals. The adoption fee does not cover the cost of the medical services an animal receives. If you adopt, would you like to help the other pets at the Roanoke Valley SPCA by making a tax deductible gift?*
- Yes
- No
Amount
My Information
Date*
MM slash DD slash YYYY
Name*
First Middle Last
Address*
Street Address City/County State ZIP Code
Home Phone #*
Work Phone #
Mobile Phone #*
Email Address*
Have you or anyone in your household ever been (i) charged with, or convicted of, animal cruelty, neglect, or abandonment or (ii) the subject of a civil proceeding to terminate your ownership rights of a dog, cat, or other companion animal?*
- Yes
- No
Have you or anyone in your household ever surrendered an animal to, or had an animal seized by an animal control officer?*
- Yes
- No
Have you or anyone in your household been convicted of domestic violence?*
- Yes
- No
My Home and Family
How many adults live in your home?*
Do any children live in your home?*
- Yes
- No
If yes, what are the ages of the children? (If not applicable, enter N/A)*
Do children frequently visit your home?*
- Yes
- No
If yes, what are the ages of the children? (If not applicable, enter N/A)*
Do you live in an:*
- Apartment
- Condo
- House
How long have you lived at your current residence?*
Are you prepared to take this pet with you if you move?*
- Yes
- No
Do you currently:*
- Rent
- Own
- Rent to Own
It is the responsibility of each adopter who rents to ensure that their landlord permits pets. By signing below, you attest that you are permitted to have pets in your home. Falsification of an adoption application may result in denial of adoption or refund in the event of a returned animal.*
Signature of Adopter
My Current and Previous Pets
Please list all of the pets you have had in the last 10 years including current pets and those you no longer own or are deceased.*
Name Dog or Cat Age Sex Spayed/Neutered? Up to date on rabies? Indoors or Outdoors Does this pet still live with you? If not, what happened to him/her?

The Roanoke Valley SPCA has the right to verify rabies vaccine history regarding all pets owned by the prospective adopter in the past 10 years. Permission is given by the prospective adopter for the Roanoke Valley SPCA to verify this information by completing the veterinarian information below.
Veterinarian*
Veterinarian's Phone #*
The Roanoke Valley SPCA will accept all returned animals within 30 days of adoption. However, returns of animals must be coordinated in advance through the Program Manager. After 30 days, the return of an animal is subject to our normal intake process and cannot be guaranteed. Roanoke Valley SPCA does not provide a refund on returned animals except as noted in the refund policy below. The Roanoke Valley SPCA reserves the right to require owners who return an animal to the Roanoke Valley SPCA to participate in a 30 day waiting period before adoption of another animal.
The Roanoke Valley SPCA will provide a full refund if the animal is returned within thirty (30) calendar days of the adoption date if the animal has been diagnosed by a licensed veterinarian, with such diagnosis documented in writing and supplied to the Roanoke Valley SPCA, with a serious medical illness or condition (including, but not limited to, parvo, distemper, panleukopenia).
RVSPCA Mask Requirements*
The RVSPCA follows all CDC guidance for mask requirements in response to COVID-19; at this point, this includes unvaccinated persons wearing a mask.
- I attest that all individuals joining me for the adoption appointment have been vaccinated.
- I will be joined by individuals who have not been vaccinated and those individuals will comply with CDC requirements and wear a mask.
I certify that the above information is true and correct to the best of my knowledge. I also acknowledge falsification of the above can result in me being denied adoption of an animal. The Roanoke Valley SPCA reserves the right to refuse any adoption.
I understand that completing the adoption application does not guarantee that I will be approved to adopt the animal.
Signature of Adopter*
Date*
MM slash DD slash YYYY
Photo ID*
Max. file size: 256 MB.
*A copy of your photo ID is required upon submission of this application. If your photo ID does not reflect your current address, please provide a copy of a utility bill showing your name and the correct address.
Issuing State*
Date Issued*
MM slash DD slash YYYY
Help us help them! How did you hear about this animal? Let us know, we want to spread the word.*
- WDBJ7
- WSLS
- WFXR
- K92
- Facebook
- Our website
- Petfinder
Name
This field is for validation purposes and should be left unchanged.

Adoption Application

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Name	Dog or Cat	Age	Sex	Spayed/Neutered?	Up to date on rabies?	Indoors or Outdoors	Does this pet still live with you? If not, what happened to him/her?