$110 Adoption Fee for Dogs

Humane Society of Wilkes Foster Adoption Application

$110 Adoption Fee for Dogs

$75 Adoption Fee for Cats

To complete on the computer, just “select” the lines with your cursor and replace them with the info you type in. On other responses, you can highlight your answers in color or just select and underline. Save your responses as a Word Document and add your last name to the file name.

Application for:______

(name of pet)

Your Name:______

Preferred Phone Number:______

E-mail Address:______

Address:______

City:______State&Zip______

Who will be responsible for the care of this pet? Self Other

If other, please specify name, age and relationship of this person to you:

If adopted, will this pet live with you? Yes No

If no, please explain:

Do you live in a..... House Apartment Mobile Home Other:______

Do you rent or own your home?______

If renting, do you have landlord’s permission to keep a pet? Yes No

Landlord’s Name:______

Landlord’s Phone:______

Please describe where and how this pet would be kept most of the time:

Is any part of your yard fenced in? Please describe:

How long would the pet typically be alone on most days?______

How many adults are in the household?______

How many children are in the household?______

What are their ages?______

Do all household members want to adopt this pet? Yes No

Please describe current and past pets (continue on back or attach page if needed):

Pet Name / Cat or Dog / Breed / Age / Sex / Current on
Vaccines / Spayed or Neutered / What Happened to
Past Pets?

Are you willing to let a HSOW member (or designee) visit your home? Yes No

Please supply the name and phone number for your current or most recent veterinarian:

______

Please feel free to write anything else that you would like us to know about you as a pet owner and/or about your plans for caring for this pet.

My signature certifies that the above information is true to the best of my knowledge, that I am interested in this pet solely as a companion animal, and that the HSOW has my permission to contact my veterinarian.

______

(Signature) (Date)