Adoption Form

HSMC Online Adoption Form

Name * First Last
Email *
Address *
Street Address

City

State / Province / Region

Postal / Zip Code

Country
Home Phone * - (###) - ### ####
Cell Phone - (###) - ### ####
Drivers License Number *
Employer / Reference Information
Employer *
Employer Phone * - (###) - ### ####
Reference Name * First Last
Reference Phone * - (###) - ### ####
Second Reference Name * First Last
Second Reference Phone * - (###) - ### ####
Housing Infomation
Do you own or Rent your home? * Own Rent
If you rent
Landlord's Name First Last
Landlord's Phone - (###) - ### ####
Number of Adult Residents *
Number of Child Residents
Age Range of Children - Youngest
Age Range of Children - Oldest
Questionnaire
What Type Of Pet Are You Interested In? *
How Many Pets Have You Owned In The Last Five (5) Years? *
Do You Still Have Them?
If Not, Why?
How Many & What Kinds Of Pets Do You Currently Take Care Of?
What Are Their Names?
Are All Of The Pets Spayed Or Neutered?
If Not, Why?
Are All Of The Pets Current On Vaccines?
If Not, Why?
Name of Veterinarian First Last
Name of Clinic
Veterinarian's Phone - (###) - ### ####
You Understand The Pet Will Need Vaccines & Regular Vet Visits? *
Are You Willing To Provide All The Vet Care Needed For The Pet's Lifetime? *
An Average Pet Lives 10 - 15 Years. Are You Prepared To Make A Lifetime Commitment To This Pet?
Under What Reasons Would You Give Up This Pet? *
Who Will Be Responsible For Caring For This Pet? *
How Many Other Pets Or Animals Are In The Household & Who Is Their Owner (roommate's Pets, Family Member's Pets, Etc..)? *
Where Will Your Pet Stay During The Day?
(inside, Outside, Indoor Kennel, Outside Kennel, Garage, Etc...) *
How Many Hours Will The Pet Be At Home By Itself? *
Where Will Your Pet Stay During The Night?
(inside, Outside, Indoor Kennel, Outside Kennel, Garage, Etc...) *
Where Or Who Will Board Or Care For The Pet While You Are On Vacation? *
How Will You Keep Your Pet From Running Away?
(fenced In Yard (how Tall?), Tie Out, Outside Kennel, Leash, Boundry Train, Electric Fence, Etc...)
Please Be Specific *
Why Do You Want This Pet?
(protection, For Child, Companionship, Gift, To Breed, To Hunt, Etc...) *
If This Pet Is A Gift For Someone, Do They Know?
If Not, Why Do You Want To Get Them This Pet?
What Will Happen To The Pet If It Is Not Wanted As A Gift?
If This Pet If For Protection, What Do You Expect It To Do?
Do You Have Any Experience With This Breed Of Pet? *
If So, What? If Not, Why This Breed?
Do You Understand That Your New Pet May Not Be Housebroken / Have Accidents Inside? *
What Will You Do To Correct & Housebreak This Pet?
Please Be Specific *
Do You Understand That Your New Pet May Chew Or Scratch Furniture, Tear Up Paper, Etc..? *
What Will You Do To Correct & Limit Destructive Behavior?
Please Be Specific *
Are You Going To Take This Pet To Training Classes? *
If Not, Why?
Do You Understand It May Take Time To Adjust To Your Home And To Other Pets? *
How Long Are You Willing To Give To Make The Adjustments Work? *
Have You Ever Adopted From The HSMC Or Any Other Animal Shelter? *
Have You Ever Taken An Animal To A Shelter? *
If So, Why?
Would You Object To A Home Visit From The HSMC? *
If So, Why?
Would You Object To A Follow-up Call From The HSMC? *
If So, Why?
Do You Understand That Approval To The Application Is At The Discretion Of The HSMC? *
At The Time Of Filling Out The Adoption Paperwork You May Or May Not Be The First Person To Apply To Adopt This Pet, You Will Be Notified Once The Internet Adoptions Are Checked By The Shelter Manager. This Is Completed On A Daily Basis.
Do You Understand This? *
Have You Answered All Of These Questions Truthfully? *
Please List The Name Of The Pet You Are Interested In. *
Feel Free To Add Any Other Comments On Why The HSMC Should Adopt This Pet To You At This Time?
Do You Understand That By Clicking Submit, You Agree that The Humane Society Of Madison County, Its Members, Staff, Volunteers, or The Webmaster Of This Website, Will Not Be Held Responsible For Any Information That Is Submited Through This Website. *
Thank You For Taking Interest In Adopting One Of Our Furry Friends. We Will Respond To This Application As Soon As Possible.

Adoption Form

Adoption Form

Employer / Reference Information

Housing Infomation

If you rent

Questionnaire

Thank You For Taking Interest In Adopting One Of Our Furry Friends. We Will Respond To This Application As Soon As Possible.