Adoption Application
Email address *
Identification
Name *
Your answer
Address (Street, City, State and Zip) *
Your answer
Phone Number *
Your answer
Employment
Employer, Position, Years of employment, business phone number *
Your answer
Housing
Do you own or rent your place? (Check all that apply) *
Required
If Renting, Landlords name, phone number and if pets are allowed? *
Your answer
If own, length of time at current residence? *
Your answer
How long do you anticipate living at your current residence? *
Your answer
House hold Members
Number of adults in household *
Your answer
Number of children and their ages in the household *
Your answer
Name of roommates *
Your answer
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 *
Your answer
Veterinarian Care
Are Current Pets... *
yes
no
Up to date on vaccinations
Spayed or neutered
On heart worm preventative
Outside pet
Veterinarian Name and Phone Number *
Your answer
Miscellaneous
Which animal are you interested in adopting?
Your answer
Where will this pet spend most of its time? *
Required
Do you have any concerns or questions about adopting?
Your answer
Why are you interested in adopting from this Humane Society?
Your answer
How much time will you dedicate to caring for your pet? *
Your answer
Where did you hear about us?
Your answer
The submission of this application authorizes Stevens Community Human Society to contact (please check all that apply) *
Required
Would you like to be added to the SCHS Newsletter email list?
A copy of your responses will be emailed to the address you provided.
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