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Adoption application
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Adoption application
Please enable JavaScript in your browser to complete this form.
Please enter the animal name, or the type and characteristics of the animal that interests you (i.e. small young male dog)
Your name:
*
Street address:
*
City, state, zip
*
Home/cell phone
*
Work phone:
How long at your present address?
*
If less than a year, list previous address:
Status:
*
Own
Rent
If renting, please provide landlord name and phone:
Please list all household members besides you:
Are you employed?
*
Yes
No
If employed, please list employer name and phone:
Are you at least 18 years old?
Yes
No
How many pets have you had in the past two years?
*
Current pet#1
Dog
Cat
Pet name:
Indoor/outdoor
Indoor
Outdoor
Spay/neuter status
Spayed/neutered
Not altered
Current pet#2
Dog
Cat
Pet name:
Indoor/outdoor
Indoor
Outdoor
Spay/neuter status
Spayed/neutered
Not altered
Current pet#3
Dog
Cat
Pet name:
Indoor/outdoor
Indoor
Outdoor
Spay/neuter status
Spayed/neutered
Not altered
Past pet#1
Dog
Cat
Pet name:
Indoor/outdoor
Indoor
Outdoor
Spay/neuter status
Spayed/neutered
Not altered
Past pet#2
Dog
Cat
Pet name:
Indoor/outdoor:
Indoor
Outdoor
Spay/neuter status:
Spayed/neutered
Not altered
Past pet#3
Dog
Cat
Pet name:
Indoor/outdoor:
Indoor
Outdoor
Spay/neuter status
Spayed/neutered
Not altered
Who will be the primary caretaker for 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 (daily and when you are on vacation):
Veterinarian reference - Clinic Name or NA:
*
Clinic address: or NA:
*
Phone or NA:
*
I CERTIFY THAT THE INFORMATION 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, SCHS reserves the right to place that animal with the applicant we believe is the best match. I FURTHER UNDERSTAND THAT SCHS RESERVES THE RIGHT TO REFUSE ADOPTION TO ANYONE if we feel it is not a safe enviornment for the animal or the home cannot provide proper vet care. PLEASE TYPE YOUR FULL NAME BELOW AS A SIGNATURE.
Date Signed
THIS SECTION TO BE COMPLETED BY SCHS - NOTES:
Please complete:
Vet check
Landlord check
Employer/self-employed check
Status of application:
APPROVED
PENDING
DENIED
Staff Signature
Submit
