Humane Society of Tipton County Adoption and Foster Application

Humane Society of Tipton County Adoption and Foster Application
Name of animal
Name
DOB
Address

Address

Street Address Line 2

City, State, ZipState / Province

Postal / Zip Code
Home Phone
Cell Phone
Work Phone
Email
example@example.com
Are you 18 years of age or older? Y or N
Are you looking to foster, adopt, or both?
1.Your household consists of

Adults onlyLive aloneAdults and children
2. If there are any children not living in the home, who visit more than 1x time weekly:
Ages
How often do they visit?
3.Does anyone in your household have allergies to cats or dogs?

YesNo
4.Do all members of your household agree to fostering/adopting?

YesNo
5. The level of activity in your home.

QuietActiveVery active
6. Do you have any current pets in your household? If yes, please describe below: Type, sex, age, spay/neutered, inside, outside, both, vaccines, years owned.
Are any of these foster animals? If yes, what facility are you fostering for?
Phone
Vet's Name
Phone
7.When away from the residence, where will the pet be kept?
8.How will you confine the pet when outside?
9.What will you do with your pet when you go out of town?
10.What will you do with your pet if you move from your current residence?
11. What training methods will you use to handle potential problems (i.e housetraining, scratching, jumping, litterbox training)?
12. Have you been accused and/or convicted of a crime that involved animal violence? If yes, explain.
13.Have you ever re-homed a pet and what was the reason?
For Adopting/Fostering Dogs
1.Do you have a fenced in yard? If yes, what kind?
2.Do you have a place where the dog can run and get exercise? If yes, how much area?
3.If your dog goes missing, what steps will you take and who will you contact?
For Adopting/Fostering Cats
1.Do you understand the necessity and agree that your kitten/cat will be inside only; having their outdoor experiences being well contained and supervised?
2.Do you understand that declawing a cat is permanently harmful and illegal in many places and do you agree to not have your kitten/cat declawed?
3.Where will you keep your litterboxes and how many will you have?
4.If your cat goes missing, what steps will you take and who will you contact?
HSTC Disclaimers
Do you understand that it is completely at the discretion of HSTC to approve/deny this adoption?

Y?N
Do you understand that if you can no longer keep your kitten/cat or puppy/dog, you will return him/her to HSTC completely and unconditionally?

YN
Do you understand that if you are fostering for HSTC that is not ownership of the animal? Ownership falls on HSTC.

YN
Do you understand that if you choose to adopt an animal you are currently fostering for HSTC that you will still need to go through the adoption process (and pay adoption fee) and it can be accepted or denied at the discretion of HSTC and that the reason for denial may not be disclosed?

YN
*A minimum of 3 references are required and they can not be anyone currently living in the household*

References

	Name:	Relation:	Email:	Phone:	Comment:	Staff/Volunteer

Applicant Signature

Clear
Date

MonthDayYear
Date
PLEASE DO NOT FILL ANYTHING OUT BELOW
Application Completion Date

MonthDayYear
Date
Application Approval Date

MonthDayYear
Date
Staff/Volunteer
Comments
Should be Empty:

Humane Society of Tipton County Adoption and Foster Application

For Adopting/Fostering Dogs

For Adopting/Fostering Cats

HSTC Disclaimers

PLEASE DO NOT FILL ANYTHING OUT BELOW