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?*YesNoAmountMy InformationDate* Date Format: MM slash DD slash YYYY Name* First Middle Last Address* Street Address City/County AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific 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?*YesNoHave you or anyone in your household ever surrendered an animal to, or had an animal seized by an animal control officer?*YesNoHave you or anyone in your household been convicted of domestic violence?*YesNoMy Home and FamilyHow many adults live in your home?*Do any children live in your home?*YesNoIf yes, what are the ages of the children? (If not applicable, enter N/A)*Do children frequently visit your home?*YesNoIf yes, what are the ages of the children? (If not applicable, enter N/A)*Do you live in an:*ApartmentCondoHouseHow long have you lived at your current residence?*Are you prepared to take this pet with you if you move?*YesNoDo you currently:*RentOwnRent to OwnIt 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 AdopterMy Current and Previous PetsPlease 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.*NameDog or CatAgeSexSpayed/Neutered?Up to date on rabies?Indoors or OutdoorsDoes 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).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* Date Format: MM slash DD slash YYYY Photo ID**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*VirginiaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificDate Issued* Date Format: 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.*WDBJ7WSLSWFXRK92FacebookOur websitePetfinderEmailThis field is for validation purposes and should be left unchanged.