Humane Society of Nelson County PET ADOPTION APPLICATION
Email address *
Name of Pet Requested *
Your answer
Your Name *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Work Phone
Your answer
What kind of pet are you here to adopt? Select all that apply. *
Required
Name of pet you are applying for:
Your answer
Why do you want a pet?
Your answer
Do you have any preferences as to breed, color, sex, age, size, length of hair, etc? *
If yes, list features important to you?
Your answer
Would this be your first experience owning a pet? *
Please list all pets you currently have in your household (ie. dog, cat, etc); what are their names; what are their ages; are they spayed or neutered? *
Your answer
Are the above mentioned pets kept inside or outside? *
How many other pets have you owned in the past 5 years? *
Your answer
What became of them?
Your answer
Who is your veterinarian? *
Your answer
Veterinarian Phone
Your answer
Do we have your permission to ask your vet to give you a reference? *
Which do you currently live in? *
Do you? *
If you rent, does your lease allow pets?
If you rent, what is your landlord's name?
Your answer
Landlord's Phone
Your answer
How long have you lived at the above address? *
Your answer
How many people live in your house hold? *
Your answer
Do all of the adults know and approve of your adopting a pet?
If there are children, what are their ages?
Your answer
Do you or does anyone living in your household have any known allergies to animals?
If yes, to what kind of animal and how severe is the allergy?
Your answer
Who will be responsible for the care of the pet? *
Your answer
THIS SECTION IS FOR CAT OR KITTEN ADOPTION
Select the reason(s) why you want to adopt a cat or a kitten:
If other, please explain:
Your answer
Where will the cat be kept?
On average, how many hours will that cat spend alone each day without human companionship?
Your answer
Do you plan to declaw the cat you adopt?
If yes, why?
Your answer
Would you declaw the cat if it became destructive or aggressive?
What problems could constitute a reason for giving up your cat?
Your answer
THIS SECTION IS FOR DOG OR PUPPY ADOPTION
Select the reason(s) why you want to adopt a dog or puppy:
If other, please explain:
Your answer
Are you willing to house-train a puppy or dog?
Are you familiar with crate training?
Have you crate trained other dogs you've owned?
Where will the dog be kept?
Do you have a fenced yard?
If no, give approximate distance to the nearest road:
Your answer
How would you keep your dog confined to your property when outside? (Select all that apply)
If other, please explain:
Your answer
Are you familiar with the leash and licensing laws in your community?
Where will the dog stay while owners are gone during work or school day?
If other, please explain:
Your answer
On average, how many hours will the dog spend alone each day without human companionship?
Your answer
Do you plan on obedience-training your dog?
If yes, on your own or in classes?
What problems could constitute a reason for giving up your dog?
Your answer
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