Adoption/Foster Application

Applicant:

First NameLast Name

Co-applicant (if applicable):

First NameLast Name

Email Address

example@example.com

Phone Number

Format: (000) 000-0000.

Name of Pet You Wish to Adopt or Foster:

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Do you currently own any pets?

Pet Name & Breed:

Are your current pets spayed/neutered? Please explain:

Disposition and behavior towards other dogs/cats?

Veterinarian Name

First NameLast Name

Veterinarian Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Do you own or rent your home?

Please provide your landlord's information here:

Do you have a yard?

Is it fenced? please describe

Have you ever surrendered a pet you own to any animal shelter including a "low" or "no kill" shelter?

Are there children in the home? (If yes, please list ages)

How many hours per day would the pet be alone?

Will you crate your pet?

If you have to leave town, emergently or planned, where would your pet stay?

How would you deal with behavioral issues such as barking, chewing, destructive behavior, bathroom accidents indoors, unruly leash behaviors in your pet?

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?

Please provide a detailed description:

By clicking the submit button, I understand a background check will be completed.
By clicking the submit button, I understand my references will be checked including veterinary and personal.
By clicking the submit button, I understand there is an adoption donation associated with adoption of a pet and that it is tax deductible according to IRS 501(c)3 guidelines. I understand this donation will ensure the organization is equipped to rescue another homeless pet.
By clicking the submit button, that if I no longer want or can no longer care for my adopted pet for any reason, I agree to notify the Muhlenberg County Humane Society (MCHS) make arrangents for my pet to be taken back into rescue.
By clicking the submit button, I agree to indemnify and hold harmless MCHS against any losses, lawsuits, claims, injury, damages incurred by me or to any persons or property by my adopted pet, once adoption has been completed.
By clicking the submit button, I understand that MCHS will disclose any of the pet's health or behavior issues known before adoption is completed.
By clicking the submit button, I verify all of the above information is true and accurate.

Date

Signature of Potential Pet Parent