Ashe County Humane Society Adoption Application

Ashe County Humane Society Adoption Application

-You MUST be 18 years of age to adopt-
Type of Pet Interested in: *
Date *

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Name of Pet Interested in: *
Applicant's Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

E-mail
Home Phone
Cell Phone
Work Phone
Why are you adopting the pet? *
Who are you adopting a pet for? *

Self Business Family Friend
Which applies to your housing situation? *
Which applies? *

House Apartment Duplex Mobile Home Lot (Mobile Home) Condo/Townhouse Live with parents/guardian Live in roommate's home
If you rent, are pets allowed?
Landlord's Name

First Name Last Name
Landlord's Phone Number

Area Code Phone Number
How long have you resided at your present address? *
Total Number of people residing at your address? *
Adults *
Children *
Ages of children?
If your living arrangements change (moving, new baby, etc.), what will you do with your pet? *
Where will the pet spend it's time? *

Indoors Outdoors Both
Where will the pet stay while you are gone during the day? *

In fenced yard Confined to area in home Outside/Unconfined Tied or fastened on a run Crated Garage Loose in home Pen/Kennel Barn/outside building
Where will the pet sleep at night? *

Run free inside home Crate/Kennel Outside/confined In bed with owner Garage Outside/unconfined Confined to one room Barn/outside building
If you adopt a dog, are you prepared to teach it not to:

Bark Jump the fence Chew Dig holes Behave aggressively
Does anyone in your household have allergies to pets? *
List pets currently owned or owned within the last three years. Please state whether the animal is a cat or dog, its age, sex, whether it has been spayed or neutered, and if the pet has been vaccinated. Also please state what happened to your pet. *
Are vaccinations current? *
Do you agree...
to have the pet examined by a veterinarian within (5) business days after adoption? *
to have the pet vaccinated by a veterinarian annually against infectious diseases? *
to provide humane care - proper food, water, and shelter? *
to provide the pet with regular preventive care, and immediate medical treatment by a licensed veterinarian if ill or injured? *
Would you allow a home visit after the adoption of your pet? *
Do you agree that this pet will be spayed or neutered at the earliest possible date using the voucher you are provided? *
I certify that the above information is complete and accurate. I give permission to Ashe County Humane Society to call my veterinarian for a reference and to perform a home visit.
Date

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Signature *

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Ashe County Humane Society Adoption Application

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