Adoption Application
Email *
Name *
Address (Street, City, State and Zip) *
Phone Number *
Employer, Position, Years of employment, business phone number *
Do you own or rent your place? (Check all that apply) *
If Renting, Landlords name, phone number and if pets are allowed? *
If own, length of time at current residence? *
How long do you anticipate living at your current residence? *
House hold Members
Number of adults in household *
Number of children and their ages in the household *
Name of roommates *
Are any members of your household allergic to pets? *
Will this pet be in contact with any individuals who may have a compromised immune system? *
Current Pets
Number of pets, Pets name, species and status *
Veterinarian Care
Are Current Pets... *
Up to date on vaccinations
Spayed or neutered
On heart worm preventative
Outside pet
Veterinarian Name and Phone Number *
Which animal are you interested in adopting?
Where will this pet spend most of its time? *
Do you have any concerns or questions about adopting?
Why are you interested in adopting from this Humane Society?
How much time will you dedicate to caring for your pet? *
Where did you hear about us?
The submission of this application authorizes Stevens Community Human Society to contact (please check all that apply) *
Would you like to be added to the SCHS Newsletter email list?
Clear selection
A copy of your responses will be emailed to the address you provided.
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