| Date: |
Pet's name you are
interested in (if applicable): |
| First Name: |
Last Name: |
| Address: |
Apt. # |
| City: |
State & Zip: |
| Home Telephone: |
Work Phone: |
| Email Address: |
| Type of Pet you are looking for: |
DOG CAT |
| SMALL |
MEDIUM LARGE |
Other specific requirements: (paraticular color, bread, long hair, short hair, temperament, etc.):
|
| PERSONAL REFERENCES: (Other than someone who lives with you) |
| Name: |
| Home Phone: |
Work Phone: |
| Name: |
| Home Phone: |
Work Phone: |
| Are you employed? Yes No |
Occuption: |
| Name of Employer: |
| Address of Employer |
| City: State: |
Zip: |
| Business Telephone |
Work Hours |
| Are you 18 years or older? Yes No |
| Who is this animal for? |
| Do you live in an Apartment House |
| Are animals allowed in your dwelling? Yes No |
| Do you have other animals at this time? Yes No |
| If Yes, how many? |
| How long have you had this animal(s): |
| What Kind? |
| Is that animal(s) spayed or neutered? Yes No |
| If no, please explain: |
| Have you ever had a pet before? Yes
No |
| If yes, how long did you have that animal? |
| Was that animal(s) spayed or neutered? Yes
No |
| Where is that animal now? Explain: |
| Have you ever adopted from The Humane Society of Caroline County, Inc. before? Yes No |
| Where is that animal now? Explain: |
| Do you or any members of your family have allergies to animals? Yes
No |
| Are there children in your home? Yes No |
| If yes, what are their ages? |
| Do you travel for business or vacation? Yes No |
| If yes, who will provide for your animal(s) while your away? Name/Phone: |
| If you share a dwelling, are other members of the household in agreement concerning the adoption of an animal? Yes No |
| If no, explain: |
| Who is your Veterinarian? |
| Name: |
| Address: |
| Phone: |
| Have you considered the daily expenses for maintaining an animal? (Medical, food, grooming, etc.) Yes No |
| Are you familiar with humane procedures for housebreaking? Yes No |
| If a behavior problem arises, are you prepared to invest the time and expense for professional training? Yes No |
| How did you hear about The Humane Society of Caroline County? |
| What size is your yard? |
| Type of Fence? |
| What size is the Fence? |
| Identification (with present address) can be supplied with your personal interview |
| Identification #1 |
| Identification #2 |
| Signature of Applicant: __________________________________________ |
| Signature of THSOC Representative __________________________________________ |
Please note: By signing this application, this does not obligate The Humane Society of Caroline to grant an adoption. By purposely falsifying information on this application will hereby make this application void. By signing this application you hereby state that all of the information is true and correct to the best of your knowledge and grant The Humane Society of Caroline County permission to check references and call on the behalf of the animals in regards to granting an adoption to you.
Please Print and send to:
Humane Society of Caroline County
4435 CCC Road
Ruther Glen, Virginia 22546
804-445-5621 |
| | |
