YCHS Pre-Adoption Application

Sumitting this application does not mean you are commiting to a dog or cat, nor does it guarantee you will get that animal. It is simply a tool we use to help both you and us identify a good potential match for your family and lifestyle.

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

Name of Pet(s) You Want to Adopt*

Please add names of ALL pets you are interested in

Adopter's Name*

First & Last Name

Drivers License # and State*

*Legal requirement to adopt an animal

Address*

Street Address

Apt/Townhouse/Condo #

CityState

Zip Code

Adopter's E-mail*

Phone Number*

Area CodePhone Number

Phone Type*

CellHomeWork

Additional Phone Number*

Area CodePhone Number

Phone Type*

CellHomeWork

Names and ages of ALL residents in your home. Include yourself and all other persons who reside in the home. Each block must have an entry. Type none in each field once you have listed all residents.*

Do you currently have any pets?*

YesNo

If you currently have pets, please list them below.

Vet reference (please call your vet & give permission to release information to us). Note, if you don't have a vet, indicate what vet you plan to use should your application to adopt be approved. *

Vet name, address & phone number

Two Personal References*

Name, email, phone and how they know you

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 or cat you can have?

YesNoIt's written in our lease

Landlord's name and telephone*

If you do not rent/lease, please type none in the box

Do you have a yard?*

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

Do you work outside the home?*

YesNoOne applicant is home/works from homeWe work different shifts

How many hours per day will this pet be alone? Please explain.*

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

YesNoYes, adults have discussed. Kids don't know yet.

We will be speaking to all adult residents to confirm everyone is aware of this application process and wants to have a pet added to the family. Please do not submit this application if you are "trying to talk someone into" adopting this pet or think "once they meet the pet, they will want one" or "I'm getting this pet as a surprise birthday present for them." In those scenarios, you are welcome to email us to discuss the pet, but we would like all adults in the home to be involved in the adoption process.

Additional reference (if desired)

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

I understand that completing this application does not guarantee I will be allowed to adopt a dog or cat, and that the application is a tool to help the Yancey County Humane Society determine if this dog and/or cat 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. I also certify that I have never been convicted of animal cruelty or neglect.

I agree to allow a representative from the Yancey County Humane Society to contact my vet for a reference. If I am approved to adopt a pet, I agree to pay an adoption fee and hand sign an adoption contract at the time of adoption.

I understand that all petss adopted from the Yancey County Humane Society will be spayed/neutered and vaccinated prior to adoption. Dogs will be microchipped and cats will be upon adopter's request.

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*

After you submit this form, it will take you back to the Yancey County Humane Society home page. Feel free to email us with any questions:

Contact ychs@ccvn.com

The Yancey County Humane Society reserves the right to reject any application based on information obtained during this screening process. Please understand that our primary goal is the health, happiness, and safety of our rescued pets.