Adoption Application

Name of Applicant: E-Mail Address:
Home Address: City: State: Zip:
Occupation: Daytime Phone: Home Work
May we call you at work?: Yes No   Fax Number:
Home Phone: What is the best time to contact you:
Name of companion animal you wish to adopt: (Leave blank if you are unsure at this time.)
Names of people along with ages of children who will be living with this companion animal:

Do ALL members of the family want this pet?: Yes No
In what type of housing do you reside?: House Townhouse Apartment Duplex Mobile Home
Do you: Rent or Own?
If you rent, are pets allowed in your dwelling? Yes or No
If you rent, please provide contact information for your landlord:


You may leave the following two questions blank if you are looking to adopt a cat.

1. Do you have a fenced yard?: Yes No. If yes, please give the type and height of fence:
2. Where will the pet be kept during the day? And at night?

Other pets in the home (names and breeds):

Are your dogs up to date on rabies vaccinations?: Yes No
Are your pets spayed or neutered?: Yes No
If adopting a cat, would it live.... Indoor Outdoor or Both?
What other pets you have had in the past and what has happened to them?

If you are forced to move and would not be allowed to take your pet, what would you do?:

Inquiring about a cat, please answer below question:
In your opinion, what is the best way to train your cat to use a scratching post? If you are unsure, please state that you will need information on training or if you plan to declaw: :

Wanting to adopt a puppy, please answer below question:
In your opinion, what is the best method to housetrain your puppy?


Please list your veterinarian's name, address and phone number for reference:
Name:
Address:
Phone:

May a HELP Humane Society officer visit your home for approvals or follow-ups?: Yes No

Applicantâs signature:
Date:
Co-Applicantâs signature:
Date: