Adoption Application

Name

Are you Over 18? Are you Over 18? Yes No

Phone

Email

Address

City

State

Zip Code

Name of pet you're wanting to adopt:

Is this pet going to be a gift? Is this pet going to be a gift? Yes No

If yes, name/phone of person who will be responsible for pet:

Do all family/house members agree to this adoption? Do all family/house members agree to this adoption? Yes No

Are you financially able to care for the pet? Are you financially able to care for the pet? Yes No

Are there children in the household? Are there children in the household? Yes No

If yes, ages of children:

Is your home owned or rented? Is your home owned or rented? Owned Rented

If rented, name/phone # of landlord (we will verify pets are allowed):

Where will this pet be spending most of its time? Where will this pet be spending most of its time? Indoors Outdoors

If outdoors, what shelter will you provide?

Where will this pet be sleeping? Where will this pet be sleeping? Indoors Outdoors

If outdoors, what shelter will you provide?

Does your home have a fenced in yard? Does your home have a fenced in yard? Yes No

If no, how will you keep the animal from roaming?

List your reasons for wanting to adopt a pet:

In the unfortunate circumstances that you are unable to keep your pet or unable to care for your pet any longer, we prefer that you bring him/her back to our Humane Society. Should you need to give up your pet (regardless of how long you have had him/her, are you willing and able to bring him/her back to this shelter? In the unfortunate circumstances that you are unable to keep your pet or unable to care for your pet any longer, we prefer that you bring him/her back to our Humane Society. Should you need to give up your pet (regardless of how long you have had him/her, are you willing and able to bring him/her back to this shelter? Yes No

If not, why?

Do you have any pets right now? Do you have any pets right now? Yes No

If yes, please list the names and breeds of each pet:

Have you had any pets in the last 3 years? (Not counting the pets you have now) Have you had any pets in the last 3 years? (Not counting the pets you have now) Yes No

If yes, please list the names and breeds of each pet and where it is now:

Provide the name, city-state and phone # of all veterinarians who have cared for past and/or current pets (Veterinary references will be contacted to verify the healthcare provided for your past/current pets):

Have you adopted from us before? Have you adopted from us before? Yes No

If yes, please list the names and breeds of each pet and where it is now:

Reference Name #1 (only 1 family member)

Reference Phone #1

Reference Name #2

Reference Phone #2

Reference Name #3

Reference Phone #3

Signature

Date