Adoption Application

Thursday, 13 December 2018

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Home AdoptionsAdoption Application

Adoption Application

The Scotland County Humane Society would like to thank you for choosing to adopt an animal from our shelter. Our goal is to provide our animals with happy permanent homes. We are interested in your satisfaction AND the health and wellbeing of our animals. In order to better meet these needs, we ask that you please fill out our adoption application before the adoption process can be completed.

Tell us About You

Name

Physical Address

City

State

Zip

Home or Cell Phone #

Work Phone #

How long at present address?

Do you own or rent?

If less than a year, list previous address

Dwelling type

If renting, provide Landlord Name & Phone #

Please list all household members

Are you employed? Yes No

Employer

Employer Phone #

Are you 18 years old or older? Yes No

How many Pets have you had in the past two years?

Please list your Current Pets

Name

Indoor Outdoor

Spay/Neuter?

Name

Indoor Outdoor

Spay/Neuter?

Name

Indoor Outdoor

Spay/Neuter?

Please list your Past Pets

Name

Indoor Outdoor

Spay/Neuter?

Name

Indoor Outdoor

Spay/Neuter?

Name

Indoor Outdoor

Spay/Neuter?

Pet Adoption Candidate

Why do you wish to Adopt this Animal?

Do you intend to Breed this animal? Yes No

Who will be the Primary Caretaker of this Pet?

Where do you plan to keep your Pet during the Day?

Where do you plan to keep your Pet during the Night?

Do you have a fenced in yard? Yes No

How Will You Care For This Pet When You Are Not At Home (On a daily basis and when you go on vacation)?

Are You Aware That Being A Responsible Pet Owner Also Means Being Financially Able To Care For An Animal During its Lifetime (12-14 yrs), Including Unexpected Illness and Injury. Are You Able and Willing To Do So?

Name of the Animal you Wish to Adopt

ID # and Pen #

Which of the Following Prompted you to Adopt From the Scotland County Humane Society?

Visiting the Shelter

Pet of the Week in newspaper

Friend or Relative

scotlandhumane.org

petfinder.com

petango.com

Adoption Clinic

Other

Certification and signature

I CERTIFY THAT THE INFORMATION PROVIDED IS TRUE. I UNDERSTAND IT IS SUBJECT TO VERIFICATION BY THE SCOTLAND COUNTY HUMANE SOCIETY. In the event that more than one application is received for a particular animal, Scotland County Humane Society reserves the right to place that animal with the applicant we believe is the best match for that particular animal. I FURTHER UNDERSTAND THAT THE SCOTLAND COUNTY HUMANE SOCIETY RESERVES THE RIGHT TO REFUSE ADOPTION TO ANYONE.

I Certify the information provided is True.

Signature Name

With my signature, I authorize the Veterinary Clinic specified below to release my animal(s) medical records to Scotland County Humane Society.

Veterinary Clinic

Thank you for submitting your Adoption Application. We will review the information you sent and contact you at our first opportunity!

Humane Society of Scotland County

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Shelter Hours

Mon, Tue, Thur, Fri
11:00am - 3:30 pm

Saturday
1:00pm - 3:00pm

Wednesday and Sunday
Closed

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