Western Hills Humane Society
Name Of Animal
Please enter a valid phone number.
Street Address Line 2
State / Province
Postal / Zip Code
Are you over 18?
How long have you lived at your current address
Do you rent or own?
If you rent, list your landlords name and phone number
Are animals allowed?
Size and number of animals allowed
Is there a pet deposit or additional pet rent required?
How much is the rent/deposit?
Name of employer
Does your job require extensive travel?
Have you ever owned a pet before?
Do you currently have any pets? What breeds?
Have your current pets been neutered or spayed?
Are your pets up to date on their vaccines?
If you have cats are they declawed?
Please list any animals you have owned in the last 5 years and what happened to them
Have you ever introduced a new pet into your home? How will you facilitate the new animal meeting your current ones?
Why are you interested in adopting?
Are you adopting this animal for you or for someone else?
Is this animal going to be:
an office pet
Are you aware of the life expectancy of your animal?
Are you aware of the medical/housing/food costs associated with owning an animal?
How did you find out about this animal?
Have you adopted from the Western Hills Humane Society before?
If so, when? Who? and do you still have this animal?
Are there any pet allergies in your family?
Do all members of your family support this adoption?
Have all adult members met this animal?
Do you have any children in the household? What ages?
Have the children been instructed on proper care of an animal?
(Dogs) what do you know about this breed?
(Dogs) have you had any experiences training?
Would you be willing to enroll your dog in obedience class?
How will you discipline your pet?
How will you handle scratching (cats) or other destructive behaviors?
If you are adopting a puppy or a kitty do you know how to housebreak an animal?
Have you ever surrendered an animal of your own into an animal shelter before?
If you have surrendered an animal, please explain why
Have you ever had to rehome an animal (to a new home other than a shelter)?
If you have had to rehome an animal, please explain why
For what reasons would you return this animal to us?
Where will the animal be during the day?
What outside space is available?
Approximate area of the yard/height of the fence
Do you have a pet door, if so where does it lead to?
If an outside pet, what shelter do you have for it?
How much time a day will your pet be alone? (without human companionship)
Where will your animal spend its time away from you?
How will you exercise your pet?
What will you do with the pet if you go on vacation?
What arrangements will you make for the care of your pets in case of an emergency or if you become unable to care for them?
Name and number of veterinarian
What is the most common reason you have visited the vet?
Are you aware of the high cost of shots and regular veterinarian costs?
Can you afford to pay for the veterinarian costs for the animals life time?
If you move, what will you do with your pet?
What will you do with your animal if for any other reason you can no longer care for it
Have you ever had an animal impounded or been issued a citation for an animal law violation?
If yes, please explain
Please tell us a little more about your family, hobbies, and interests:
Please list 2-3 references (not living with you). Please list their name, number, and how you know the person and how long you have known them for.
I would like to discuss the following with my adoption counselor:
I certify that the information given on this application is true and accurate to the best of my knowledge. In understand that providing any false information can be cause for denial of my application or future forfeiture of the adopted pet. Leaving any question blank or not filling out this form completely can be cause for the application to be discarded or denied. By choosing to adopt, I understand that I am expected to make a considerate commitment of time and money to this animal for his/her lifetime, up to 20 years in some cases.
I understand that WHHS may make periodic house visits and /or telephone inquires to ensure the well-being of the animal I am adopting. I agree to cooperate full and thoughtfully with WHHS inquires and to allow WHHS to see my animal upon request. In understand that WHHS has the right to take possession of the animal, at its discretion, if during a visit WHHS determines that animal is not being properly cared for.
If the animal is not already spayed or neutered there is an additional $75.00 spay/neuter deposit that is refundable once we receive notice that the spay or neuter procedure is done by the date indicated on your health exam and spay/neuter contract.
“I understand the terms and conditions of this adoption and acceptable responsibility for its known and unknown health issues.”
I, the undersigned, hereby release the Western Hills Humane Society from any and all liabilities pertaining to the adoption of the above-mentioned animal.
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