Ashe Humane Society Adoption Application

TODAY'S Date *

Month Day Year

Name of Pet(s) Interested in: *

Applicant's Name *

First Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

E-mail *

Phone number you can be reached *

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 Mobile Home Condo/Townhouse Live with parents/guardian Live in roommate's home Part-year living in Boone area for school

RENTERS: Are pets allowed? (Please check with landlord or lease in advance.)

RENTERS: If you are allowed to have pets, are you required to have an ESA (Emotional Support Animal) completed form?

RENTERS: Landlord's Name (required if renting)

First Name Last Name

RENTERS: Landlord's Phone Number (required if renting-we will call them!)

Area Code Phone Number

How long have you resided at your present address? (Present address is the place that the pet will live when it leaves the rescue) *

Total Number of people residing at your present address? (Present address is place the pet will live when it leaves the rescue) *

Adults at present address. *

Children at present address *

Ages of children under 18 at present address?

If your living arrangements change (moving, new baby, moving from a residence at school etc.), what will you do with your pet? *

Where will the pet spend it's time? *

Indoors Outdoors Both indoors and outdoors

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

Confined to area in home Outside/Unconfined Crated Garage Loose in home Barn/outside building

Where will the pet sleep at night? *

Run free inside home Crate/Kennel In bed with owner Garage Outside/unconfined Confined to one room Barn/outside building

Does anyone in your household have allergies to pets? *

List all household member's pets CURRENTLY owned. Please state whether the animal is a CAT or DOG, and also. NAME, AGE, SEX, and BREED (dogs only). *

Are all of the CURRENT household member's pets spayed or neutered? If not, why not? *

Are vaccinations up to date on the all CURRENT household member's pets, if not why not?

List all household member's pets you have owned IN THE PAST 3 YEARS BUT NO LONGER WITH YOU. Also please state what happened to your pet. Please denote which pet(s) are owned by you and which ones are another household member's/roommate. *

Veterniarian or Practice Name (required if you have pets - we will call them)

First Name Last Name

Veterinarian Phone# (required if you have pets - we will call them!)

Area Code Phone Number

to have the pet examined by a veterinarian within (30) 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? *

that this pet will be spayed or neutered at the earliest possible date using the voucher you are provided? *

to set up a wellness appointment prior to final adoption, if you don't currently have a pet and/or do not have a veterinarian. *

that I assume full responsibility for the welfare of this pet from the date of adoption *

by clicking the submit button, I understand that if I no longer want my pet, or am no longer able to care for my adopted pet, I will be directed to surrender my pet to the Ashe Humane Society. I will give them 72 hours notice of that return. *

by clicking the submit button, I verify all of the above information is true and accurate. *

What else would you like us to know?

Please watch for an EMAIL from us (ashehumane@skybest.com). We will respond within 48 hours with additional questions, application approval or declining the application. Thank you

Date *

Month Day Year

Enter the message as it's shown *

Ashe Humane Society Adoption Application

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