Adoption Application

Adoption Application
Animal Name*
Type of Animal*
Dog Breed*
ADOPTER INFORMATION
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Do you own or rent? *
IF YOU RENT, YOU MUST ATTACH LANDLORD APPROVAL FOR ANIMALS WITH APPLICATION!!
Number of people living in household? *
If any minors live in household, what are the ages?
Email*
example@example.com
Pets you own currently or have owned in the past five years (include type, breed, gender, indoor/outdoor, and whether you still own or why you don't own any longer): *
References (include a minimum of two, name and phone #)*
Please add phone numbers
Please list employment history for the last 3 years. Include name of business, job title, employment dates.*
Current Veternarian (please include phone #)*
Living arrangements for animal being adopted:*

IndoorFenced YardOutside PenHigh AcreageOther
I understand and agree that the adoption fee for this animal will be at the current advertised fee(includes spay/neuter certificate, rabies, and microchip). *

Powered by Jotform SignClear
Sterilization Information
Sterilization is mandatory! This animal must be sterilized within 30 days of adoption if an adult or at 6 months of age if a puppy.
Adoption Agreement
I understand the Jasper County Humane Society has the right to disallow any adoption for any reason.

I understand the Jasper County Humane Society has the right to visit my new dog or cat and verify their living conditions and health.

I understand, agree, and accept that if the Jasper County Humane Society for any reason finds the placement of this animal not acceptable, they will reclaim the animal.

I release the Jasper County Humane Society and their agents of any liability relative to this adoption.

Important

This animal may not be transferred to a new owner for any reason without prior approval from the Jasper County Humane Society.
Adopter Signature*

Powered by Jotform SignClear
Name*

First NameLast Name
Date*

MonthDayYear
Date
Jasper County Humane Society Representative Signature

Powered by Jotform SignClear
File Upload

Cancelof
Should be Empty:

Adoption Application

ADOPTER INFORMATION

Sterilization Information

Adoption Agreement