Humane Society of Jackson County Pet Application

Humane Society of Jackson County ARF

Online Adoption Application Form
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Phone Number

Area CodePhone Number
Type the name and the description of the dog you are interested in (and a second choice, if you have one)
What made you decide on a dog?
Type of dwelling:
How long have you lived there?
Have you ever had dogs before?

YesNo
Have you ever had to give up a dog?

YesNo
If yes, for what reason?
How many other pets do you have and what are they?
If you have had pets that died in the last five years, please explain the cause/circumstances.
Do you live on a college campus?

YesNo
Do you have permission from your landlord and /or everyone in your household?

YesNo
Name of landlord, if applicable.
Does anyone in the household have allergies to pets?

YesNo
Will this animal be a service animal

YesNo
If you answered yes to the service animal question, please explain the type of service the pet will perform.
Do you have a secure fence or lot?

yesNo
Who will train, feed and exercise animal?
Will the dog be tied up or chained?

YesNo
Where will the dog be kept at night?
Who is your Vet? (please give name and phone number as we will contact them for a reference)
May we visit your home before and after adoption?

YesNo
Provide a reference that is not family member

First NameLast Name
Reference Person's Number

Area CodePhone Number
* I / we agree that if we adopt a dog, we will provide professional vet care, a nutritious diet, and a loving home.

*We also agree that we will return the dog if we can no longer keep it.

*No member of our household has ever been convicted of cruelty to animals.
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Humane Society of Jackson County ARF