Helping Hands Humane Society
Pet Adoption Profile

Potential Pet Parent Information

Prospective Pet Parent*

First NameLast Name

Date of Birth*

Date

Spouse/Partner Name

First NameLast Name

Email Address*

Phone Number*

Area CodePhone Number

Secondary Phone Number

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Driver's License Number

If you live out of state (we are in Kansas), your adopted pet will require a health certificate ($20) and the adoption process will take at least two days. Do you acknowledge that you will contact our adoption team ahead of time if you have further questions about this to plan your adoption?*

YesNo

Family Information

Do you own or rent your home?*

OwnRentRent to Own

Home Type*

If you rent, please provide your landlord's/apartment complex's contact information here:

Do you live with your parents, a family member, or a friend? If so, please provide their relationship to you.

Please list the number of adults and children in your home as well as ages of children.*

How often do children visit the home?*

DailySometimesRarely

Please list all current animals that live in your household - name, breed, age, sex (m/f), spayed/neutered?, current on vaccinations?, adopted from HHHS? if so, when?, and where they primarily live.*

Final Questions

Are you aware of the city and county laws regarding pets, including city licensing and leash laws?*

YesNo

It may take your new pet six weeks or longer to adjust to your home, usually longer if other pets are involved. Are you prepared to allow this much time to adjust?*

YesNo

Do you understand that an animal's behavior in the shelter may be different than behaviors exhibited at home?*

YesNo

If you are interested in any particular currently adoptable pets, please enter their name and ID numbers here:

By electronically signing below, I certify that the information I have given is true and that any misrepresentation of facts may result in my losing the privilege of adopting a pet. I understand the Helping Hands Humane Society has the right to deny my request to adopt an animal. I authorize the investigation of all statements in this application. I authorize the request of all veterinarian records by the Helping Hands Humane Society. I understand this application is the property of Helping Hands Humane Society.

Signature of Potential Pet Parent*

Thank you for your interest in adopting! We appreciate your desire to welcome a homeless pet into your family. Best of luck on this exciting journey!

Helping Hands Humane SocietyPet Adoption Profile

Potential Pet Parent Information

Family Information

Final Questions

Helping Hands Humane Society
Pet Adoption Profile