Adoption Application

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*** Warrick Humane Society Adoption Application *** Please fill out all areas as honestly and to the best of your knowledge. All areas MUST be filled out or the application will not be considered for adoption.   PERSONAL INFORMATION
Full Name:
Age:
Phone Number:
Cell Number:
Work Number:
Email Address:
Street Address:
City:
State:
Zip Code:
Employer:
Employer Number:
Spouse/Partner/Roommate ** If information is the same as above, leave blank **
Full Name:
Age:
Relationship to above applicant:
Cell Number:
Work Number:
Email Address:
VET INFORMATION ** If you do not have a vet you will need to provide the information to a vet office you plan to use before approval **
Vet Name:
Vet Address:
Vet Phone Number:
Last Visit to Vet:
PERSONAL REFERENCE INFORMATION ** When providing personal references please choose people that are not related to you **
Personal Reference #1
Full Name: Phone Number: E-mail Address: How they know you:
Personal Reference #2
Full Name: Phone Number: E-mail Address: How they know you:
Personal Reference #3
Full Name: Phone Number: E-mail Address: How they know you:
ENVIRONMENT
Please list the names and ages of all the people living in the household
1: 2: 3: 4: 5: If more then 5 >
Is everyone in the household in agreement to the adoption of a new pet?
	Choose Yes No
Is the adoption of the pet going to be a surprise or gift for someone else?
	Choose Yes No
How long have you lived at your current address?
CURRENT LIVING SITUATION
Do you live with your parents?	Choose Yes No
Do you live ...	Choose In an Apartment In a House In a Condo In a Mobile Home/Trailer
Do you live ...	Choose In the Country In the Suburban In the City
Do you rent?	Choose Yes No
Landlord's Name:
Landlord's Phone #:
Do you have a yard?	Choose Yes No
Is it Fenced?	Choose Yes No
If YES, what type of fence and how tall is it?
Does it have a gate?	Choose Yes No
Can it be locked?	Choose Yes No
PETS LIVING SITUATION
How many hours a day will the pet be left alone?
	Choose Under 1 hour 2 to 4 hours 4 to 6 hours 8+ hours
If 8+, please explain:
Where will the pet be left while you are gone?
Where will the pet spend most of its time?
What food do you plan to feed the pet?
ADOPTION INFORMATION
Why do you want a pet?
Have you adopted a pet before?
	Choose Yes No
If YES, From where?
Have you ever owned a pet?
	Choose Yes No
Age Preference
	Choose Puppy (8 weeks thru 6 months) Young Adult (7 months thru 1 year) Adult (2 years +) Senior No Preference
Sex Peference
	Choose Male Female No Preference
If interested in a specific pet or are requesting to be put on our file for a certain breed, please put what or who you are applying for here.
Can you patiently handle house training and/or other behavioral issues?
	Choose Yes No
What issues can you NOT tolerate?
CURRENT AND PREVIOUSLY OWNED PETS
Please give the name, ages and type/breed of all the pets you currently have. Example: Name: Lily  Age: 1 year old   Type/Breed: American Bulldog  Where is the Pet Kept: In the house with our family
Current Pet #1
Name: Age: Type/Breed: Where is the Pet Kept:
Current Pet #2
Name: Age: Type/Breed: Where is the Pet Kept:
Current Pet #3
Name: Age: Type/Breed: Where is the Pet Kept:
More then 3 pets? Please add the here.
Are your pets spayed and/or neutered?
	Choose Yes No
Are your pets up to date on all their required vaccinations?
	Choose Yes No
Are your pets currently on Heartworm Preventative?
	Choose Yes No
Name: Age: Type/Breed: Where is the Pet Kept:
Please list all the pets you have had in the past 3 years that are not listed above. Where they are now and why? Example: Name: Brutus - Rottweiler  Age: 6 years old  Where & Why: Put to sleep 3/05 because of cancer
Previous Pet #1
Name: Type/Breed: Where and why:
Previous Pet #2
Name: Type/Breed: Where and why:
Previous Pet #3
Name: Type/Breed: Where and why:
Additional Comments
CERTIFICATION: Please read the following very carefully. By signing this adoption application you hereby certify that all the above information is true and correct and agree to the following terms to be considered for adoption of a rescued Pet. I understand that the previous history and/or heritage of any particular pet is unknown prior to them being accepted into Warick Humane Society.  I understand that providing any false or misguiding information on this application will result in immediate denial of my application.  I understand that ALL animals placed by Warick Humane Society will be spayed or neutered before adoption and will not ask Warick Humane Society to deviate from this mandatory policy.  I understand that if I am approved for adoption, that although I may state a preference that the final decision as to what pet I will be allowed to adopt is that of Warick Humane Society and I agree to adhere to their advice.  I understand that Warick Humane Society is under NO obligation to approve my application and reserves the right to deny ANY application without cause or reason.   I am 21 yrs of age or older, financially and emotionally capable of caring for, training, and providing a stable environment for a Rescued Pet.  I will supply all medical care and every other needs to meet the well-being of this pet and I will provide proof of vet care to Warick Humane Society if required at any time. By pressing the "Submit" button below you attest that you have read the above Certification and agree to the terms therein. Furthermore you represent that the information you have provided on this form is the truth to the best of your knowledge and belief. Thanks you for considering adoption!!

Warrick Humane Society is a 501 C 3 non-profit organization. Your donation may be tax deductible to the fullest extent of the law.