Adoption Application Online Form | Humane Society of Rowan County NC

Name*

Street Address*

City, State and Zip*

Are you 21 years of age or older?*

Yes

No

Home Phone

Cell Phone

Email*

Are you looking to adopt a*

Dog

Puppy

Cat

Kitten

What size animal are you looking for?*

Would you consider adopting an animal with special needs?*

Yes

No

Do you want this pet for:*

Companion

Protection

Breeding

Gift

Other *

If other, please explain

How many hours per day will this pet be without human companionship? How many days per week?*

Where will your pet be kept during the day? (check all that apply)*

Indoors

Outdoors

Crate

Where will your pet be kept at night?*

Indoors

Crate

Do you plan to let your cat outdoors?

No

Yes*

If Yes, how often do you plan to let your cat outdoors?

Do you prefer a declawed cat?

Yes

No

What is your living arrangement?*

Single Family Home

Apartment

With parents

With roommates

I rent

I own

If renting, what is your landlord's name and contact info?

If renting, does your landlord allow pets?

Yes

No

Not sure

If renting, is a deposit required, and if so, how much?

If renting, will there be a monthly increase in your rent payment? And if so, how much?

Do you have a fenced in yard?*

Yes *

No

If Yes, what is the fence height and type

How many adults live in your home and what are their ages?*

How many children live in your home and what are their ages?

What other pets are in the home?

Is anyone in your home allergic to

Cats

Dogs

What will you do with your pets if you move in the future?

How much do you anticipate spending yearly to feed, vaccinate, and provide medical care for your pet"s needs?

Would you be willing to allow a representative from the HSRC to visit your home before the adoption is completed?

List all the pets you have owned in the past 10 years and what happened to them.*

What is (was) the name of the veterinarian who cared for these pets? What is their location and phone number?

May we contact this veterinarian for a reference

No

Yes *

If yes, please contact the veterinary clinic and give your permission for staff to speak with a Humane Society of Rowan County representative about the general veterinary care of your pet(s).

I have done so

I will let HSRC know when I have done this

Do you realize that a dog or cat may live 15 or more years?

It may take your new pet two or more weeks to adjust to its new home, especially if other pets are involved. Are you prepared to allow this much time?

Yes, I am willing to allow this much time.

No, I am not willing to allow this much time.

How do you plan to train your dog?

How do you plan to house train your dog?

By signing below, I certify that the information I have given is true and that I recognize that any misrepresentation of the facts may result in my losing privilege of adopting a pet. I authorize investigation of all statements on this application. *

Entering name here signifies certification of all information

Enter today's date here

Enter valid NC driver's license number here

ADOPTION APPLICATION

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