Adoption Application

You will be required to complete an application before adoption, ALL feilds are required. Your application will then be reviewed by our professional staff. Some pets may require a homevisit. We also reserve the right to deny ANY application without cause or reason.

*** 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?