Making Friends Adoption Application Make A DonationBecome A Volunteer Anderson Humane Society Online Adoption Application Adoption Application (Redo) Your Information Date * Email * Name * First Last * Last Address * Address Address Address City City State Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State Zip Code Zip Code Home Phone * Work / Cell Phone Is there a particular pet we have that you are interested in? If so, which one? * What type of pet are you looking for? List any specifications that are important to you: Are you adopting for: * Yourself Your family Both Please check any of the reasons below for adopting a pet: * Family Pet Adult Companion Companion for Other Pet Protection Mouse/Barn Pet Child's Pet Please list all children and their ages. * Please check the applicable living situation: * Own House Rent House Rent Duplex Own Condo/Townhouse Rent Condo/Apt./Townhouse Parent's House Own Mobile Home Rent Mobile Home Live with Roommate If you rent, a signed permission letter from the landlord is required. Please list the landlord's name and phone number: * Will this animal be primarily: * Indoors Outdoors Both Where will this animal stay while the owners are gone during work or school? * Garage Barn Outside Crate Loose in home Confined to area inside home Inside a fenced yard How many hours per day will this animal be alone each day? Please list Weekdays and Weekend. * If this animal were to become overly destructive, what action would you take to correct the behavior? * Does anyone in your household have allergies to cats or dogs? * Yes No How much would you plan to spend on this pet yearly including food, treats, toys, medical care, etc.? * $10-$50 $50-$100 $100-$300 Over $300 What problem(s) do you think would constitute a reason to give up your pet? * Pet Information Please list any and all particulars of pets you currently own or have owned in the past. Introduction Pet Name * Dog or Cat? * Dog Cat Male or Female? * Male Female Spayed or Neutered? * Yes No Breed * Current Age * History Age of pet when acquired * Age of pet when last owned * What happened, if no longer owned? Health Date of last vaccinations * Health Status * Veterinary's Name * Veterinary's Phone Number * Veterinary's Address * Veterinary's Address Veterinary's Address Veterinary's Address City City State Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State Zip Code Zip Code List any current problems with the pet * Add Additional Pet Remove Additional Pet Adoption Terms & Consent Would you object to an Authorized Representative of the Anderson Humane Society Adoption Center visiting your home prior to adoption? * Yes No Would you object to a follow up visit or for them to verify any of the above information? * Yes No Is there anything you would like to tell us regarding why you feel you could provide a good home for this animal? Why should we choose you over other applicants that may be wanting to adopt this particular animal? * Should you be unable to keep this animal after adoption, you MUST return it to the animal shelter. Do you agree that you will surrender the animal back to us should you not be able to keep it? * Yes No Thank you for filling out this adoption application. It is not our intent to invade your privacy; our sole purpose is to find a caring, responsible and permanent household for our animals and at the same time find a suitable pet for you to love and enjoy for many years! By signing this form, you give consent that all information pertaining to this form is accurate to the best of your knowledge. Your online signature will be representative of a print signature. I have read and agree to the terms of the Anderson Humane Society Adoption Application. * I agree e-Signature * Date * Submit Application
