Kokomo Humane Society | Adoption Application
729 E. Hoffer St. | Kokomo, IN 46902 | 765.452.6224 | KokomoHumane.org
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Number
*
Ex. 765-437-5555
Alternative Number
*
Ex. 765-437-5555
Email
*
example@example.com
Please Confirm Your Email
*
example@example.com
Which way do you prefer to communicate?
Email
Text
Phone Call
Place of Employment:
Work Phone Number
-
Area Code
Phone Number
I am...
Employed full-time
Employed part-time
Attending school
N/A
Have you ever adopted from the Kokomo Humane Society before?
*
Yes
No
If so, when?
Would you like to join our email list?
*
Yes
No
Would you like to receive an email about a trial of free Pet Insurance?
*
Yes
No
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Household Information
Type of residence (e.g. house, mobile home, apartment):
*
This residence is…
*
Rented
Owned
With family/parents
Landlord Name:
*
First Name
Last Name
Landlord's phone number:
*
-
Area Code
Phone Number
*If a rented apartment, name of apartment complex:
*
How long have you lived here?
*
Do you plan on moving in the next 6 months?
*
Yes
No
In the next year?
Yes
No
How many individuals live in your current household?
*
Man
Women
Seniors
Children
Quantity
Please list the ages of the children currently living at the household?
*
Do children visit your home frequently?
*
Yes
No
If so, what ages?
*
Who in the household would be responsible for the care of your pet?
How would you describe your household?
*
Very active
Moderately active
Somewhat active
Quiet
Very quiet
Do any individuals in the household have allergies/ asthma?
*
Yes
No
What is the severity?
If so, what kind?
Dogs
Cats
Rabbits
Other
What other animals do you have in the household?
*
Type of animal/breed
Age
Sex
Spayed/Neutered
Adopted from KHS?
Pet 1
Pet 2
Pet 3
Pet 4
Pet 5
Are all of your animals current on vaccinations?
Yes
No
What veterinarian do you use?
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New Pet Information
Which pet are you interested in adopting?
*
Please provide the pet ID number
*
Pet ID number can be found beside animal profile picture. Ex:32229174
How did you hear about this pet?
*
Friend
Social Media
Shelter visit
KHS Event
Other
What is your reason for adopting your new pet?
*
Mouser
Companion family pet
Companion for other pet
Watch dog
Other
Where will your pet be kept during the day?
Indoors or Outdoors
At night?
Indoors or Outdoors
How many hours a day will your pet be left alone?
*
*For dog adopters: Is your yard fenced?
*
Yes
No
*Are you prepared to spend time house-training a dog if necessary?
*
Yes
No
*How will the dog be confined when outdoors?
*
Tied up
Fence
Kennel
Doghouse
Other
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All Adoptions
I agree that if for any reason I can no longer keep my pet that I will not sell or give it away, but I must return it to the Kokomo Humane Society.
*
Agree
Disagree
I understand that any pet adopted MUST be spayed or neutered and that the Kokomo Humane Society reserves the right to spay or neuter any animal, at any time, while in our adoption program.
*
Yes
No
I understand that (1) adopting this pet is a long-term commitment, (2) the Kokomo Humane Society reserves the right to refuse/reject my application at its discretion, (3) My signature on this application releases any information necessary to process this application.
*
Yes
No
I agree to call the Kokomo Humane Society 24 hours after filing my adoption application, if not already been contacted by a staff member.
*
Agree
Disagree
It may not be known if an animal has been exposed to an illness or has a hidden injury or genetic disorder. Under these circumstances we cannot guarantee the health of any pet. We would not knowingly adopt or place an animal with a serious medical condition. You may have other basic medical concerns such as ear mites, internal parasites (worms), or external parasites (fleas). If your veterinarian should determine a more serious condition during the initial health exam, you may return the animal to the Kokomo Humane Society. You may choose to keep the pet, but all further costs are your responsibility. All refunds or exchanges are subject to the approval of the executive director.
Date
*
-
Month
-
Day
Year
Date
Signature of applicant:
*
Clear
Submit
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