Canine Adoption Form "*" indicates required fields Step 1 of 7 14% Animal Name*Date* MM slash DD slash YYYY Name*Driver's License #*Physical Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Primary Phone*Secondary Phone*Email* Employer/Occupation*How long have you been at your current job?* Provide 2 references that are NOT members of your immediate family Reference Name*Phone*Years Known*Relationship*Reference Name*Phone*Years Known*Relationship*How did you hear about Rita B. Huff Humane Society?* Friend/Family Member Facebook Internet Other Other* Please read all the following information BEFORE filling out the adoption application. If you have any questions, please ask. Requirements for Adopting: All applicants must be 18 years of age or older. All adopted animal must be spayed or neutered before leaving the shelter if they are of age. No exceptions. If the animal has is not yet of age, an appointment will be made to bring the animal back for the sterilization. Under state law, all animals over the age of 3 months must be vaccinated against rabies. If the animal is of age, this will be done before the animal leaves the shelter. If the animal is younger than 3 months old, an appointment will be made to bring the animal back for the rabies vaccination. While the first vaccinations are included in the adoption fee, it is the owners' responsibility to vaccinate their pet annually. If the applicant rents a house or apartment, any pet deposits required by the landlord or management company must be paid prior to adoption. This will be verified by Rita B. Huff Humane Society's staff before the animal is released. Requirements for Adopting: Animals are different from humans. The actions of animals are often unpredictable. Animals should always be closely supervised when they are with children. The Rita B. Huff Humane Society makes no claims regarding the behavior or temperament of the animals placed into adoptive homes. However, if you decide the animal will not work out with your family, you may return the animal to the shelter within 7 days for a full refund. The Rita B. Huff Humane Society has no control over the diseases an animal may have been exposed to prior to coming to the shelter. There are no guarantees that the animal will be completely healthy. You should take your adopted animal to a licensed veterinarian as soon as possible. The Rita B. Huff Humane Society is not responsible for any veterinary fees you may incur after the adoption is complete. Applicant Signature*Applicant Print Name*Date* MM slash DD slash YYYY What kind of home do you live in?* House Apartment Townhouse Other Other*Your home is* Owned, by you or spouse Rented from owner or management company Owned, by someone else within the house Rented as part of a group of roommates Other Other*If renting, is your name on the lease?*If renting, do you have your landlord's permission to have a pet?*Landlord's Name*Landlord's Phone Number*Who shares your household?* Spouse Boyfriend/Girlfriend Roommate(s) # Other Other*Are there children in the home?* Yes No if so, how many and what ages?*Do you plan to move soon?* Yes No Does anyone in your household have an allergy to animals that you are aware of?* Yes No Is someone home during the day?* Yes No if so, who?*How many hours will your pet be alone each day?*Where will your pet spend most of their day when you are home?* Indoor Garage Yard Enclosed Patio Indoor/Outdoor Other Other*Where will the pet stay when they are home alone?* Indoor/Outdoor (Doggy Door) Inside Only Outside Only Specify* Run of the house Crate Other Other*Specify* Yard Garage Enclosed Patio Other Other*When will the animal be inside?*When will the animal be Outside?*Where will the animal be kept at night?* Indoor/Outdoor (Doggy Door) Inside Only Outside Only Specify* Run of the house Crate Other Other*Specify* Yard Garage Enclosed Patio Other Other*What rooms are off limits?*Additional Information* Do you have a yard?* Yes No What outside area is available to the pet?* Front yard Back yard Enclosed Patio Dog house Garage Other Other*Do you have a doggy door?* Yes No Is your yard shared with neighbors?* Yes No Is your yard fenced?* Yes No, my yard is not fenced If so, specify* Chain link Chicken wire Horse paneling Electric fencing Privacy/Wood Barbed wire Cattle paneling Invisible fencing Other Other*Have you recently inspected the condition of your fence for holes or loose points?* Yes No If your pet will have free access to a fenced in yard, where is it located?* Front yard Back yard Other Other*Which of the following is used to secure your gate?* Latch Padlock Keyed Lock Other Other*If your gate does not have a lock, are you willing to install one?* Yes No Who has access to your yard?* Gardner Housekeeper Pool man Delivery man Utility man Neighbor(s) Postal worker Other Other*Where will your pet be kept while they are working?*Do you trust your workers not to let you pet get out?* How would you describe your pet-owning experience?* I had pets of my own as an adult I grew up with pets, but have not owned any as an adult I have never had a pet or have limited experience with animals Other Other*How many pets have you owned in the past 5 years?*Describe the pets currently in your careNameTypeBreedAgeKept Where?Time in Your CareSpayed/Neutered?If no, why not?Describe the pets currently in your careNameTypeBreedAgeKept Where?Time in Your CareSpayed/Neutered?If no, why not?Describe the pets currently in your careNameTypeBreedAgeKept Where?Time in Your CareSpayed/Neutered?If no, why not?Describe the pets currently in your careNameTypeBreedAgeKept Where?Time in Your CareSpayed/Neutered?If no, why not?Are your pets on heartworm prevention?* Yes No If so, what kind?*Are your pets of flea/tick prevention?* Yes No If so, what kind?*Have you had experience with behavioral or medical issues with your past or current pets?* Yes No If so, please explain*If there are children in the home, please describe their experience with animals* Why do you want to adopt a rescued pet?*What are your reasons for getting a pet?* Family pet Companion Gift for someone else Child's Companion Protection/Guard Dog Companion for Another Pet Other Other*How will you exercise your pet and how often?What type of training are you interested in doing with your pet?*What methods do you intend to use to housetrain your pet?*Would you be willing to enroll your pet in obedience classes?* Yes Only if i had problems No How would you discipline your pet if they misbehaved?*If your pet develops behavioral problems, what will you do?*In which of the following situations might you allow your pet off leash?* Public Park Hike Neighborhood Walk Dog Park Private yard Beach If your pet got out or lost, what would you do?*What kind of food will you feed your pet?* Dry Kibble Canned Brand*Brand*Pets are investment of your time and money. Can yo afford to provide medical care, grooming, proper diet, shelter, and exercise for your new pet?* Yes No Are you able to make a long-term commitment to care for your pet for its entire lifespan, which could be as long as 15 years or more?* Yes No What is your monthly budget for your pet?*Who is your veterinarian?*NamePhoneLocationIf you do not have a veterinarian, would you like a referral?* Yes No If you move what will happen to your pet?*Have you ever adopted an animal from a shelter, rescue, or animal control agency?* Yes No If so, where?*Which of the following reasons might force you to give up your pet?* Excessive barking Biting aggression Shedding/Dirty Potty training difficulties Digging Not trainable Aggressive on leash Destructive chewing Divorce/Separation Allergies Moving/Relocating Financial Problems Growling at Guests Excessive Vet Bills/Chronic Illness Pregnancy of Owner Nips/Bites Children New Partner Doesn't Approve Pets Aren't Getting Alone None of the Above Other Other* Please read and initial each statement belowAgreement before signature* I understand that the Rita B. Huff Humane Society does NOT have complete medical history for the animal I am applying for.*Agreement before signature* I agree to take my new pet to the veterinarian of my choice for a health examination as soon as possible.*Agreement before signature* I understand that any diseases or conditions that the pet may have could be transmitted to my other pets.*Agreement before signature* I understand that I may need to isolate the animal away from my other pets until my veterinarian can examine my new pet.*Agreement before signature* I understand that a home visit may be required prior to final placement and I understand that a home visit does not guarantee placement.*Agreement before signature* I understand that if I am approved to adopt this animal, I MUST return the animal to the Rita B. Huff Humane Society if I am at any point unable to keep it.*Agreement before signature* I release and waive from liability or responsibility the Rita B. Huff Humane Society and/or any employees, board members, or volunteers in the event that any damages to persons or property are caused either directly or indirectly by this animal that I am applying for.*Applicant Signature*Date* MM slash DD slash YYYY Applicant Print NameCAPTCHACommentsThis field is for validation purposes and should be left unchanged. Δ
