Pet Adoption Application

Dogs/Puppies $100.00

Cat/Kittens: $80.00

Working Program: $40.00

Fees are payable via check, PayPal, Venmo or Cash and must be paid at time of adoption

** If you are filling this out to foster with us in the space for name of pet please place what you are willing to foster **

**UTD Rabies is a mandatory requirement for all pets within the home.

Sumitting this application does not mean you are guaranteed the pet you are filling out the form for. It is simply a tool we use to help both you and us identify the best potential match for your family and lifestyle along with the pets needs. We do NOT go on a first come first serve but rather a best possible fit for the pet.

A successful adoption depends on selecting the right pet for your household and a good understanding of the pets needs and care requirements. Please help us with this process by answering the following questions fully & completely. THANK YOU!

(If not filled out fully/completely the application is invalid and will not be considered/review.)

Process can take up to 72 hours to start review.

Name of the pet you want to adopt*

Adopter's Name*

First & Last Name

Co-Adopter's Name

First & Last Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Adopter's E-mail*

Co-Adopter's E-mail*

Phone Number*

Area CodePhone Number

Phone Type*

CellHomeWork

Names and ages of all permanent residents of your home (adults/children)*

Do you currently have any pets?*

YesNo

If you currently have pets, please list them below.

Are your current pets altered?

YesNoWill be within the next 30 days, appointment has been scheduled. (We will call your vet to verify this.)

If your current pets are not altered, please explain why below.

Vet reference with contact information (please call your vet and give permission to release information to us)*

Vet name, address & phone number

Two References with contact information. *

In the last 5 years have you surrendered a pet within the following states*

If you have surrendered a pet please explain.

Is anyone in your home allergic to...?*

DogsCatsNone

If you answered no to the question above, please contact your town/county/condo assoc and ask them what the regulations are.

I/We live in a*

Do you rent or own this property?*

RentOwn

Renters, have you contacted your landlord to find out if there's any restrictions on the kind or size of dog you can have?

YesNoNot yet, but I willIt's written in our lease

If you rent, you must show us a written letter from your landlord or a copy of the section of your lease stating that you are allowed to have dogs and showing any limitations.

If you live in a condo or townhome, you must show us written proof that you are allowed to have a dog there and show any restrictions.

Do you have a yard? (Mainly for dogs)*

Yard, fenced with a vertical fenceYard, fenced with invisible fencingYard, no fenceNo yard (apartment/condo/townhome)

Have you discussed this adoption with all members of your household?*

YesNo

Do you have any additional comments, questions or concerns? Anything else you would like us to know to help match you up to a dog?*

I understand that completing this application does not guarantee I will be allowed to adopt a pet, and that the application is a tool to help Spencer County Humane Society determine if the pet and my family are a good fit for each other. I acknowledge that all information provided on this form is true and correct. I understand that any misrepresentations may result in my not being approved and/or removal of the adopted pet from my possession. I also certify that I have never been convicted of animal cruelty or neglect.

I agree to allow a representative from Spencer County Humane Society to contact my vet for a reference and also agree to allowing a home visit prior to adopting this pet if they deem it necessary. If I am approved to adopt a pet, I agree to pay a non-refundable adoption fee and hand sign an adoption contract at the time of adoption.

I understand that all pets adopted from Spencer County Humane Society will be spayed/neutered, tested in the matter of health, wormed, and vaccinated prior to adoption.

Please read the above, check this box, sign, and click Submit.*

I/We have read and understand all of the above.

Applicant's Signature*

Co-Applicant's Signature

Signature date*

Spencer County Humane Society Pet Adoption Application