Form

Roane County Humane Society Pet Adoption Application

* Denotes Mandatory Field
Dog/Cat I am interested in:*
Full Name*
First Name Last Name
Co-applicants name:

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number*
- Area Code Phone Number
E-mail*
Instructions:

Please answer each question completely as there is a reason for each one. We need as much information as possible to ensure the best match for you and the animal you are applying for.Should you not have a preference, just write "Doesn't Matter". (Place N/A in any field not required.)
Although all animals available for adoption are sterilized, what sex do you prefer?*
Age preference*
Color preference*
Coat preference*
Breed or mix preference*
Activity preference*
Describe your ideal pets behavior personality.*
Should your ideal pet have any other traits/preferences that we might need to know in order to help you find the best potential pet? If so, please list.
I absolutely love pets that*
I absolutely cannot tolerate pets that*
My lifestyle is best described as*
I want a pet because*
Who will be primary care giver for the pet?*
Who is the pet primarily for?*
Why do you want a rescue pet?*
How will your pet get exercise?*
Where will your pet be kept during the day?*
Where will your pet be kept during the night?*
Will the pet be allowed in the house?*
Will the pet have run of the house?*
Will the pet be blocked off from certain areas of the house?*
Will the pet be chained outside?*
Will the pet live outdoors?*
Will the pet be exercised daily?*
Do you have a fenced yard?*
If yes, please describe the fenced in area.
Will the pet be allowed to run free outside of the fenced yard?*
How many hours a day will the pet be left alone? (Without humen contact)*
Do you currently have other pets?*
CURRENT Other Pets . Names, breeds, type, age, sex, disposition, weight, height, Spayed or Neutered?
FORMER Other Pets . Names, breeds, type, age, sex, disposition, weight, height, Spayed or Neutered?
Do you travel frequently?*
If yes, Where will your pet be when you travel?
If you move in the future what will happen to your pet?*
If something happened that make it impossible to keep your pet what would you do and who would care for your pet*
Why do you think you would be a good adopter for a rescue pet?*
Please list ALL members of your household with their names and ages:*
If you do not have small children living with you, will your pet come in contact with small children (under the age of 10)?*
Does anyone in your home have allergies?*
If yes, what kind of allergies?
Do you own or rent your current home?*
How long at current residence?*
If you rent has your landlord provided written permission for you to have a pet?*
Landlords Contact Information.
First Name Last Name
Phone Number
- Area Code Phone Number
May we visit your home prior to application approval?*
Have you ever sold, given away, or surrendered a pet to a shelter, pound, or Humane Society*
If So, WHY?
Have you or anyone in your family, member/household ever been cited for leash law violations or animal cruelty?*
If it ever becomes necessary to relinquish this pet, are you willing to agree to return it to the HSRC?*
Other rescues may have a pet you might be interested in, do we have your permission to forward your application to them?*
References:
Vetranarians Contact Information*
First Name Last Name
Phone Number*
- Area Code Phone Number
Do we have permission to contact your vet regarding pets past and present?*
If a client of the above listed vet for less than a year, please give previous vets name and phone number?
Do we have permission to contact your previous vet regarding pets taken to their practice for care?*
Personal References (non family members):
Personal reference (name and phone number):*
Personal reference (name and phone number):*
Personal reference (name and phone number):*
By submitting this form, I attest that the information provided on the application is true and accurate to the best of my knowledge and belief. I understand that falsification of information may result in denial of my application.*

I AGREE
Should be Empty:

Roane County Humane Society Pet Adoption Application

Instructions:

References:

Personal References (non family members):