CANINE ADOPTION APPLICATION
Humane Society of the Delta
P O Box 3218
West Helena AR 72390
(860) 341-1181
adopt@humanesocietyofthedelta.org
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PLEASE FILL THIS OUT COMPLETELY If your application is incomplete, it will result in a delay in processing, or denial of your application.
It takes a lot of time and effort for our volunteers to process applications.      ................................................................................................................................                                                                                                        PLEASE DO NOT APPLY TO ADOPT UNLESS: You are prepared to commit to a dog,  you have already discussed it with your family, AND can pick them up as soon as they are available.                                                                                                                                                ................................................................................................................................WE CANNOT "HOLD" ANIMALS FOR PEOPLE.                     ................................................................................................................................                                                                                                                   If you have vacation coming up, PLEASE postpone applying!                                                                                                                                                       ....................................................................................................................................................................Please verify that you've read this................................... *
Date *
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Name of the pet (s) you would like to adopt *
Adopter's Name (First and Last) *
List ALL adults who live with you (First and Last Name) and places of work if applicable.
PLEASE NOTE: Due to State Specific Animal import laws, we are not able to adopt to residents of Rhode Island, Massachusetts, New Hampshire, or Maine. In the text box below, please write out which state you reside in.
Address: Street *
City, State, Zip *
Home Phone
Cell Phone *
Age *
Home Ownership Status *
If you checked "own" for home, whose name is the home under?
Residence Type *
If you live in your parent's house, please provide their name and number.
If you rent, please provide your landlord's name, phone number, AND e-mail address.  EMAILS speed up the process substantially, if you have your landlords email that would be preferable.
I plan to contact my landlord to give them notice they will be hearing from the Humane Society of the Delta
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Who do you live with? Please check any that live with you. *
Required
Number of children and ages
Is anyone in your household allergic to pets? *
If anyone if your household is allergic to pets, please explain who is allergic and to what.
Employed *
Place of Employment: Address, City, State, Work Phone, Position and length of Employment *
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