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Second Chance for Pets
P.O. Box 243
Clinton, IL 61727
phone: 217.935.3488 secondchanceforpets@yahoo.com

Adoption Application

You must be at least 18 years old to fill out an application.

To begin the adoption process, please fill in the application below. After your application is submitted, a Second Chance representative will follow up with you to discuss next steps.

An * next to a question indicates a required field. If the question does not pertain to you or the animal you are applying to adopt, indicate "N/A" or your application will not be submitted.

Name of pet you are applying for:
*Your Name: First & Last
*Email Address:
*Home Address:
*State, Zip Code:
*Home Phone:
Work Phone:
*Length of time at address:
*Do you: Own your home
If you own a home, does your homeowners insurance company allow the breed you are applying to adopt?
If you rent, please provide your landlord's name and telephone number:
*Your occupation:
*Why do you want to own a dog or cat?
*Have you owned a dog or cat in the past 7 years? Yes
*Do you own any pets now? Yes
Please list your current pets: species, breed, sex, name
For pets you no longer own, what happened to them & approximate year you gave away/re-homed/died?
*Please list the name and phone number of your current vet or vet for pets you owned in the past. (List the last name that these pets' records would be under.)
If you have not owned a pet, what experience do you have caring for pets?
*Please list two personal references and their telephone numbers (NON-RELATIVES)
*Is someone home during the day at your residence? Yes
*Where will the pet be kept during the day?
*Where will the pet be kept during the night?
*Who else lives in your home? (Names, ages, relation to applicant)
*Do you have a fenced in yard? Yes
If your yard is fenced, please describe the fencing. (What type, how high, etc.)
If your yard is not fenced, how do you plan to confine your pet in your yard? (Question does not pertain to cats)
*Describe your exercise plan for your new pet?
If you are applying to adopt a dog, would you be willing to take it to obedience classes if necessary? Yes
*Have any of your animals (past or present) ever been impounded by Animal Control, Humane Society, rescue organization, or Department of Agriculture? Yes
If yes, where and for what reason?
*Have you ever relinquished any animals to any Animal Control Agency, Humane Society, rescue organization, or Department of Agriculture? Yes
If yes, why was the animal(s) relinquished?
*Are you willing to have a Second Chance representative visit your home to verify it is suitable for the adopted pet (by appointment only)? Yes
*List your pet preferences (species, breed, sex, age, color, size)
How did you hear about DeWitt County/Second Chance adoption program?