Pottawatomie County Caring Hearts Humane Society

First page

Applicant(s) *

Email *

Phone *

Address *

City *

State *

Zip *

Employer *

Employer's Phone *

Contact Information

Name of pet you are interested in *

How did you hear about the pet? *

Have you ever adopted an animal from a rescue/shelter agency? *

yes

no

Have you ever had an application for adoption rejected? *

yes

no

Why do you want to adopt this pet? *

What do you think are the most important responsibilities in owning a pet? *

If a disciplinary or behavior problem arises, what steps will you take to deal with the issue? *

Pet Information

For whom are you adopting this pet? *

self

gift

Do you currently have other animals? *

yes

no

List the type of animal, breed, sex, age & approximately how long you have owned them:

What pets have you had in the past and where are they now?

What precautions will you take to introduce a new pet into your home? *

Pet Owner Background

What kind of routine veterinary care do you plan to provide for your new pet? *

Veterinary care, food, treats and toys can be very expensive. Are you prepared for this expense? *

yes

no

How many people currently reside in your home? *

If you have children, what are their ages?

Do you have roommates? *

yes

no

Home Enviroment

Who will be responsible for feeding, watering, and cleaning up after your new pet? *

Do you own or rent your residence? *

own

rent

Are pets allowed? *

yes

no

Is there an additional charge for pets?

yes

no

Where do you live? *

Do you have a fenced yard? *

yes

no

Where will your new pet be kept? *

Where will your new pet sleep at night? *

When you are home, where will your new pet be kept? *

When you are at work, where will your new pet be kept? *

If you plan to crate your pet while you are at work, how many hours will he be confined? *

How frequently do you make business/vacation trips? *

What will you do with the pet when you travel? *

References

Have you ever been convicted of a crime involving animals? *

yes

no

List name and phone number of your Veterinarian *

List name and phone number of two personal references. *

Please tell us anything else you would like us to know while we are considering your application for

I pledge that the above information is true and complete. Further, I give permission to contact my landlord and my veterinarian. If the animal is not already spayed or neutered I agree to have this done within the first 30 days of adoption or when the animal is six months old whichever is appropriate.

I agree to the above pledge

Send a copy to your email

Adoption Application for Pott. County Humane Society