Adoption Application

Have you picked a specific animal to adopt?

Yes

No

*If answered Yes, please put the animal(s) name below!

Animals name:

First name

Last name

Date of Birth

Month

Day

Year

Phone

Email

Address

Street Address

Address

Address Line 2

Address

City

Dropdown

State

Address

Zip Code

Employer Name

Your Occupation

Work Phone

Type of Dwelling

Apartment

Condo/Townhome

Mobile Home

House

Do You Rent or Own?

Rent

Own

How long have you lived at this address?

Do you have a fenced yard?

Yes

No

How did you hear about us?

How did you hear about this particular animal?

Please list names and ages of everyone living in the home

Do you currently have any pets in the home?

Yes

No

If you have a pet, who is your veterinarian?

Have you ever adopted from a shelter before?

Yes

No

Have you ever had any of the following experiences with a pet?

Lost

Stolen

Ran Away

Other

Have you ever moved with pets?

Yes

No

Would you ever expect to take the pet with you if you ever move again?

Yes

No

Have you had an animal on your premisises in the last 3 months with a contagious disease?

Yes

No

On average, how much time per day will the animal be without supervision?

Less than 2 hours

2-6 hours

6-8 hours

More than 8 hours

How will your animal be cared for while you are away for an extended period? e.g., vacation

Under what circumstances can you envison giving up a pet?

If you are a resident within the city limits of Sterling, are you familiar with the current animal control ordinances?

Yes

No

Did you know the average cost of a dog is $400-$600 per year including vaccination, food, grooming, boarding, and medical care? Sometimes this cost can be significantly more.

Yes

No

Did you know the average cost of a cat is $200-$400 per year including vaccination, food, grooming, boarding, and medical care? Sometimes this cost can be significantly more.

Yes

No

CONSENT

I have read the provisions included on this questionnaire and fully understand the adoption process required by the Logan County Humane Society. I understand that by submitting the Pets/People Profile that it is in no way a guarantee of approval of adoption at this time. I certify that the above information is true and I understand that false information may result in the nullification of this adoption.

Check One

Yes, I understand

No, I do NOT understand