Adoption Application

Name of Applicant: E-Mail Address:
Home Address: City: State: Zip:
Occupation: Daytime Phone: HomeWork
May we call you at work?:YesNo   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?: HouseTownhouseApartmentDuplexMobile Home
Do you:Rent orOwn?
If you rent, are pets allowed in your dwelling?Yes orNo
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?

What is the maximum number of hours the pet will be left alone?
Other pets in the home (names and breeds):

Are your pets up to date on vaccines?: YesNo
Are your pets spayed or neutered?: YesNo
If adopting a cat, would it live.... IndoorOutdoor orBoth?
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?:

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?: YesNo

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

   
All out of area calls will be returned collect (to control our expenses).

WE RESERVE THE RIGHT TO REFUSE ADOPTION FOR ANY REASON
INCOMPLETE APPLICATIONS MAY DECREASE YOUR APPROVAL RATING.

If you would prefer to print and mail this form (there will be a longer processing time) please mail it to...

HELP Humane Society
PO Box 18
Raymore, MO 64083
or
fax to: 816.331.5291

To report problems with this form, please contact:

Webmaster Kat

Disclaimer: Any material contained on this site was either created by HELP Humane Society volunteers or it has been obtained through public distribution channels and is assumed to be either "public domain" or free, non-commercial distribution that is allowed by the copyright holder.. However, if you hold copyrights to any material contained on this site and wish it to be removed, please contact Help Humane Society by e-mail and provide legal documentation of your copyright.

HELP Humane Society and/or the Webmaster of this site are not responsible for any direct, indirect, incidental, or consequential damages resulting from adoption or providing a home for any animal pictured or described. HELP Humane Society and/or the Webmaster does not give any guarantee regarding animal availability, health, behavior, or breed. HELP Humane Society and/or the Webmaster are not responsible for the accuracy of the information contained herein, either explicit or implied. External links to other sites, some of which may be commercial or may change in character or quality, are intended for informational purposes only and do not necessarily constitute endorsement by HELP Humane Society and/or the Webmaster.