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Adoption Application- Humane Society of Port Jervis/ Deerpark
Please answer all questions 
Email *
First name *
Last name  *
Street address *
City *
State  *
Zip code *
County  *
Phone number  *
Other phone  *
Email address  *
What animal are you applying for? *
Are you at least 21 years old?  *
Name/ number of personal reference #1 *
name/number of personal reference #2 *
Are you currently employed? *
Who in the household will care for the pet? 

 *
What type of home do you live in?  *
Do you own or rent your home?  *
How long have you lived at your current residence?   *
If you rent have you received the landlord's approval to have an animal?  *
If you rent, please provide your landlord's name and phone number

 *
Does your landlord, homeowner's association, county/township/municipality have any restrictions?
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Is your yard fenced?  *
What type of fence?  *
What is the height of the fence?  

 *
How many children reside in your household? 

 *
Please list the ages of the children that reside in your home.  *
Does anyone in your house have allergies to pets or asthma?  *
If you have children have they been around pets before?  *
Who will care for your pet when you go away on vacation? 

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In the unfortunate event you pass away or are no longer able to care for the pet, do you have arrangements for your pet(s) continued care? If so, please explain.
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Why are you interested in adopting a pet at this time?
 
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Veterinarian's Name and Phone Number. If this is your first pet, please provide who you will use going forward.


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