TWIN COUNTY HUMANE SOCIETY
ADOPTION APPLICATION
We will not process this application unless it is COMPLETE!
Name:__________________________________________________________
Address:_________________________________________________________
City:_________________________State:_________Zip:____________
Home Phone:(_____)______________________
Work Phone:(______)______________________
Best time to call:__________________________
E-Mail Address:______________________ Date of Birth:________________
Will the pet reside at the address indicated above? Y N
Do you own or rent your home? ________________________________
If you rent, do you have your landlord's permission to have pets?_____________
If you rent, we will need to contact your landlord. Please provide
their name and
phone number _________________________________________________
Do you have a fenced yard?_______ Fence Type____________
Fence Height_________
If no, how will the dog get exercise, etc._________________________________________
How many adults in your household?_________
How many children and ages_______________________________________
Are all family members in agreement about adopting this dog?____________
Do you own other dogs?________ Cats?__________ Other pets?__________
Are they spayed or neutered?______________________
Do you have a regular veterinarian?_______________
Veterinarian's Name:_______________________________________________
Address:________________________________________________________
Phone(______)__________________________________________________
Where will the dog spend the day?______________________________
How and where would it be confined?___________________________________
How many hours will the dog spend alone?________________________
Where will the dog sleep at night?_______________________________
Do you agree to license this dog and give it regular health care?___________
Do you provide regular heart worm preventative and flea preventative
for your pets?______________
Do you agree to contact the Twin Co. Humane Society if you can
no longer keep this animal?____
Will you allow a representative of Twin County Humane Society
to visit your home?______
If no, why__________________________________________________
Please give a brief description of the type of dog you are looking
for, such as size, male or female, age, temperment, etc.
__________________________________________________________
__________________________________________________________
I acknowledge that all the above information is current and accurate
to the best of my knowledge and that any willful misrepresentations
will result in the termination of any adoption procedures. The
TCHS reserves the right to remove the animal from my home if it
is determined I am not providing the care it needs. I am able
to provide verification of name and address.
Signed___________________________________
Date________________________ |
