Adoption Application

HUMANE SOCIETY OF UNION COUNTY ADOPTION APPLICATION

This 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

Today's Date *

ADOPTION PET INFORMATION

Are you interested in a cat or dog?CatDog

Name of cat or dog?

YOUR INFORMATION

Your Name *

Street Address *

Apartment, suite, etc

City

State

ZIP / Postal Code

(No PO Boxes)

Contact Phone *

Email *

Age *

Are you a Veteran?Yes

Employment *Employed Full TimeEmployed Part TimeSelf-EmployedNon EmployedHomemakerRetiredStudent

Name of Employer

Marital StatusMarriedSingleDivorced/Widowed

SPOUSE OR SIGNIFICANT OTHER'S INFORMATION

Name of Spouse or Significant Other

Age of spouse/significant other (if applicable)

Employment status of spouse/significant otherEmployed Full TimeEmployed Part TimeSelf-EmployedNon EmployedHomemakerRetiredStudent

Name of Employer

LIVING SITUATION

Please list any children who live in your home and their ages

(if applicable)

Does anyone else live in your home? *YesNo

Names and ages of anyone else living in your home

Does anyone in your home suffer from allergies/asthma *YesNo

What best describes your living situationOwn your homeOwn condo/townhomeRent your homeRent condo/townhome

How long have you lived at this address

If less than 2 years, list previous addresses and landlords

Do you have a fully fenced yard *YesNo

On a typical day, how long will your pet be alone *Fewer than 4 hours4 - 6 hoursMore than 8 hours

What do you expect the monthly expenses will be for your new pet *$50 or less$50 - $100More than $100

Who will be the pet's primary caretaker *

Where will you keep your pet during the day *

Where will your pet sleep at night *

What is your plan for training your pet *

HISTORY OF PET OWNERSHIP

Have you ever taken a pet to a shelter, sold a pet, or found a new home for a pet *YesNo

If yes, please explain

Have you ever owned a pet *YesNo

Do you currently own any pets *YesNo

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 death

VETERINARY INFORMATION

If 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 *

Veterinarian's Name