Adoption Application
This questionnaire must be completed by anyone interested in adopting a pet from the Henry County Humane Society-Geneseo. We at the HCHS-G try to place our animals into permanent, responsible homes while matching the pet to you and your lifestyle. NOTE: THE PROVIDING OF FALSE INFORMATION HEREIN WILL RESULT IN THE FORFEITURE OF ADOPTION FEES AND ANY ANIMALS ADOPTED. We reserve the right to refuse an adoption based on poor or incomplete vet history.
Name of Applicant: *
Your answer
Address: (Street, City, State, ZIP) *
Your answer
Home Phone: *
Your answer
Cell Phone: *
Your answer
Email: *
Your answer
How long have you lived at your current address? *
Your answer
What kind of pet are you looking for? *
Please indicate the reason for adopting a pet (check all that apply): *
Required
Are currently employed? *
If you are not employed, is someone else in the household employed? *
Are you over 18 years of age? *
Are you interested in adopting for: *
Do you live in a: *
Do you own your own home? *
If no, does your lease allow pets? *
If you do not own a home, please list your landlord and phone number so we may contact them:
Your answer
Who lives in your household? *
Your answer
Do all members know that you plan to adopt a pet? *
What are the ages of the children in your household? *
Your answer
Does anyone in your household have allergies? *
Your answer
Will an adult be home during the day? *
Your answer
Who will be responsible for taking care of your pet? *
Your answer
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