Adoption Application

Warren County Humane Society

* First Name

* Last Name

* Street Address

* City

* State

* Zip Code

* Phone Number

Cell Phone

* Best time to call?

* Email Address

* What Specific Dog/Cat are you interested in adopting?

What other Rescues have you applied to, if any? If none write N/A.

Veterinary Information

We require a vet reference, if you do not have a vet then please provide a personal reference. Your reference should not be a relative.

* Your Vet's Name/Alternate Reference

* Vet's Street Address

Address Line 2

* City

* State

* Zip Code

* Phone Number

Email Address, if known

Household Information

* How many adults live in the house?

* How many children live in the house?

If children are in the home what are their ages and do they like dogs/cats?

* Do you have regular animal visitors that visit your home that the dog must get along with?

* Do you own other dogs/cats

Yes

No

If yes, state breed, age and gender of dog/cat and if your other dogs are cat friendly.

* If you have dogs, are they spayed and/or neutered?

* If not, why not?

* Do you own cats?

Yes

No

If yes, indoors or outdoors?

* Do you have any other animals (hamsters, guinea pigs, ferrets, rabbits, etc?)

If Yes, Please describe

* Do you own your home?

Yes

No

* If you rent, do you have permission from your landlord to have a dog/cat?

Yes

No

N/A

* Have you insured there are no size limitations if interested in adopting a larger dog?

Yes

No

N/A

Landlord's Name and Phone number

* Do you live in a:

* Where will the dog/cat be left when you are not home and how long will the dog be left alone at a time?

* Where will the dog/cat spend the day?

* Where will the dog/cat spend the night?

Indoors

Outdoors

How will the dog be kept in your yard when outside?

* How many hours on average per day will the dog spend alone? (Just answer N/A for Cats)

Filing of this application in no way guarantees your adoption of a dog from Warren County Humane Society. By typing your name into the signature block below, your application attests that the information you have given is accurate and true and also gives your current and past veterinarian permission to provide any and all information requested by us in regard to medical and preventative care provided any current and past pets they have on record. The information contained in this application is material to our decision to place a dog into a home and becomes part of the contract in the event you adopt a dog from Warren County Humane Society.

* Signature

* Date

* Indicates Response Required