Please enter your e-mail address. If a record is found in our system that matches, that information will be used; otherwise you'll enter your contact information at the end of this process. Alternatively, if you already have an account, you can log in here.
E-mail address:    
  Required
GLYNN COUNTY ADOPTION QUESTIONNAIRE Please fill in and click save at the end. Your application will be sent to us.
REFERENCE CHECKS MAY BE COMPLETED PRIOR TO APPROVAL OF ADOPTION.
Required DATE and TIME:
Required FULL NAME:
Required DRIVER'S LICENSE # and STATE ISSUED:
Required HOME STREET ADDRESS:
Required HOME CITY, STATE, ZIP CODE:
HOME PHONE:
WORK PHONE:
CELL PHONE:
EMERGENCY PHONE:
EMAIL ADDRESS:
PLEASE CHECK ONE. RESIDENT OF:


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IF YOU RENT:
LIST LANDLORD OR PROPERTY MANAGER and PHONE:
DOES YOUR LEASE ALLOW PETS?

DOES YOUR LEASE REQUIRE A PET DEPOSIT?

IF YES, HAS DEPOSIT BEEN PAID?

IS THERE A WEIGHT OR BREED RESTRICTION FOR DOGS?

IS THERE A LIMIT FOR TOTAL PETS ALLOWED?

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WILL THIS ANIMAL BE KEPT OUTSIDE?

IF YES, DO YOU HAVE A SECURE FENCE?

Required WHAT IS YOUR REASON FOR ADOPTING THIS PET?
Required DO YOU HAVE PETS IN YOUR HOME NOW?

LIST TOTAL NUMBER OF DOGS CURRENTLY OWNED:
LIST TOTAL NUMBER OF CATS CURRENTLY OWNED:
ARE ALL CURRENT PETS SPAYED OR NEUTERED?

IF NOT, PLEASE EXPLAIN WHY NOT:
ARE ALL CURRENT PETS UP-TO-DATE ON VACCINATIONS?

ARE ALL CURRENT DOGS ON HEARWORM PREVENTATIVE?

IS EVERYONE IN YOUR HOME AWARE OF YOUR INTENTION TO ADOPT THIS PET?

ARE THERE ANY CHILDREN IN YOUR HOUSEHOLD?

IF YES, PLEASE LIST THE TOTAL NUMBER OF CHILDREN and AGES.
DOES ANYONE HAVE ALLERGIES TO ANIMALS?

DO YOU CURRENTLY HAVE A PRIMARY VETERINARIAN?

IF YES, INDICATE NAME AND PHONE:
OTHER THAN CURRENT PETS, PLEASE LIST TOTAL NUMBERS OF DOGS and CATS OWNED IN PAST 5 YEARS:
ARE YOU WILLING TO PROVIDE PROOF OF THIS PET'S REQUIRED INITIAL VET CHECK WITHIN 7 DAYS OF ADOPTION?

Required WHO WILL BE RESPONSIBLE FOR THE CARE OF THIS ANIMAL?
HAVE YOU EVER RECEIVED AN ANIMAL-RELATED CITATION OR HAD AN ANIMAL IMPOUNDED?

ARE YOU AWARE THAT THE PET YOU ARE ADOPTING MUST BE SPAYED OR NEUTERED ACCORDING TO GEORGIA LAW?

Required REFERENCE NAME and PHONE:
REFERENCE NAME and PHONE:
REFERENCE NAME and PHONE:
I ATTEST UNDER GEORGIA STATE LAW THAT THE ABOVE INFORMATION IS COMPLETE AND ACCURATE TO THE BEST OF MY KNOWLEDGE.
Required COMPLETE NAME:
YOUR APPLICATION WILL BE SENT TO US WHEN YOU CLICK THE SAVE BUTTON BELOW.
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OFFICE USE ONLY
CHECK ONE:


COMMENTS:
REVIEWING STAFF MEMBER NAME:
SIGNATURE:_________________________________ DATE:______________________________________