Adoption Application for Sanilac County Humane Society
FOR FASTEST RESULT PLEASE BE SURE TO COMPLETE EVERY QUESTION
The Pet you are applying for:
Animal's Name:
Date:
Adopter Information
First Name:
Last Name:
Spouse/Partner's Last Name:
Spouse/Partner's First Name:
Address:
City:
State:
Zip:
Cell Phone Number:
Phone Number:
Email Address (Required):
PLEASE provide the correct email address and check your email frequently, as we may communicate with you via email initially, and it is important that we are able to reach you.
How long have you lived at the above address?
Are you over 18?
Yes
No
Do you live with your parents?
Yes
Yes
No
No
Are you employed?
How long?
Do you live in a :
House
Apt.
Condo.
Mobile Home Park
Mrg. Home Comm.
Duplex
Other
Do you own your home or rent?
Own
Rent
Are you head of the household?
Yes
No
If not, does the head of household agree to this adoption?
Yes
No
How many children are living in your household (please give ages)?
Do all members of the household know you're adopting a pet?
Yes
No
No
Yes
Do any members of the household object to your plan to adopt?
No
Do any members of the household have allergies?
Yes
Yes
No
Do you run a day care?
Who will be responsible for taking care of the new pet?
If yes, how many ?
How many hours per day are the children there?
If adopting a dog: What method will be used for housebreaking? (Please describe in detail)
How will chewing or destructive behavior be handled? ( Please describe in detail)
Vet Information
No
Yes
Do you agree to have annual checkups and all vaccinations up to date?
Who is your regular/previous veterinarian,or what vet will you be using?
Vet:
Clinic:
State:
Phone:
City:
How many pets do you currently own?
Please list:
Yes
No
Have they all been spayed/neutered?
No
Yes
Are they all current on vaccinations?
Have you had an animal die in the past six (6) months?
Yes
If yes, What happened?
No
At Home
No
Will anyone be home during the day for the new animal?
Yes
If NO, how long will the animals be left alone, and where will the animal stay while alone?
How will you contain the pet while it is outside?
Rent
Own
Do you rent or own your current residence?
If RENTING: Landlord's Name:
Phone:
Will the landlord allow pets?
Yes
No
Date adoption occurred?
Yes
No
Have you ever adopted a pet from this or any other shelter before?
Where is this pet now?
Have you had a dog die on your premises of distemper, parvo or unknown causes within the last 6 months?
Yes
No
Cats:
Maybe
Yes
No
If you are interested in adopting a cat or kitten, do you plan on letting him or her outdoors?
Have you had a cat die on your premises of distemper, leukemia, FIV, or unknown causes in the last 6 months?
Yes
No
Inside
Outside
No
Do your pets live:
Yes
Are your current pets on Heartworm Preventative?
Are you willing to assume the expense and time to take your pet to the vet for full preventative and medical care?
Yes
No
Yes
No
Are you aware that the cost per pet for shots and routine preventative care is between $100 and $200 per year?
Yes
Do you have a yard or is a yard available to your new pet?
No
Is the yard completely fenced?
Yes
No
What will you do with the pet when you go on vacation?
If you have to move, what will you do with your pet(s)?
What times would be convenient should a representative from SCHS wish to visit your home after adoption to assure your pet's well being?
References
Please provide the name and phone number of a personal references that is not related to you.
Name:
Phone:
THANK YOU!!!
Thanks for taking the time and effort to complete our Adoption Application. We feel it necessary to assure the most compatible homes in the best interest of both the animals and the owners.
BY SIGNING THIS APPLICATION YOU CERTIFY THAT YOU ARE 18 YEARS OF AGE OR OLDER AND THAT YOU AUTHORIZE YOUR VET TO RELEASE PET INFORMATION TO SCHS
