Adoption Application HUMANE SOCIETY OF UNION COUNTY ADOPTION APPLICATIONThis Questionnaire will help you think about how a rescued pet might impact your life. A pet is a commitment of 10-20+ years; please give pet ownership serious consideration before deciding to welcome any animal into your home. Incomplete applications will not be considered. I have read the above statement Yes DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920ADOPTION PET INFORMATIONAre you interested in a dog or cat? Dog Cat Name of dog or cat YOUR INFORMATIONYour name* First Last Street Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code (No PO Boxes)Best Contact Phone*Email* Age* Are you a Veteran? Yes Employment* Employed Full time Employed Part time Self-Employed Not Employed Homemaker Retired Student Name of employer Marital Status Married Single Divorced/Widowed SPOUSE OR SIGNIFICANT OTHER'S INFORMATIONName of Spouse or Significant other First Last Age of spouse/significant other (If applicable) Employment status of spouse/significant other Employed Full time Employed Part time Self-Employed Not Employed Homemaker Retired Student Name of spouse’s employer LIVING SITUATIONPlease list the names and ages of any children and adults other than you and your spouse/significant other living in the home.*(If applicable)Does anyone in your home suffer from allergies/asthma* Yes No What best describes your living situation?* Own a home Own condo/townhome Rent a home Rent Apartment/condo How long have you lived at this address? If less than 2 years, previous address and landlordDo you have a fully fenced yard?* Yes No On a Typical day, your pet will be alone* Fewer than 4 hours 4-6 hours More than 8 hours What do you expect the monthly expenses to be for your new pet?* $50 or less $50-100 More than $100 Who will be the pet’s primary caretaker?*Where will you keep your pet during the day?*Where will the pet sleep at night?*What is your plan for training your new pet?*HISTORY OF PET OWNERSHIPHave you ever taken a pet to a shelter, sold a pet, or found a new home for one? Yes No If yes, please explainHave you ever owned a pet?* Yes No Do you currently own any pets?* Yes No If yes, please provide us with the following information for each dog/cat: Breed/Size, Age, Male or Female, Indoor/Outdoor/Both, Spayed or Neutered? Current on heartworm prevention? Friendly to other dogs, cats, people?Please list any pets that have died in the last 5 years and cause of deathVETERINARY INFORMATIONIf you do not currently see a veterinarian, please give us the practice you plan to use when you adopt. Please notify your veterinarian's office that the Humane Society of Union County will be in contact with them to release information. Clinic name* Clinic phone number*Veterinarian’s name First Last PERSONAL REFERENCESName and contact numbers for personal references not related to youFull name (reference #1)* First Last Phone number*Full name (reference #2)* First Last Phone number*OTHERThinking of the future. In the event something happened to you, and you were no longer able to care for your pet, what would be your plan for your pet?*Any additional comments or questions you would like to share with our adoption teamPlease upload your current vet records if you have them in a digital format. Drop files here or Select files Accepted file types: jpg, png, pdf, gif, Max. file size: 50 MB, Max. files: 10. THE HUMANE SOCIETY OF UNION COUNTY 704-283-9126 HSUCinfo@gmail.com Mail: 4015 Waxhaw Hwy., Monroe NC 28112 FollowFollowFollow MONROE LOW COST SPAY/NEUTER CLINIC 704-292-7729 Monroespayneuter@gmail.com FAX: 704-292-1007 Hours & Appointments - Click Here 1404 E Franklin St., Monroe, NC 28112 Guidestar Seal of Transparency [/db_pb_signup]
