Are you Adopting
a Dog or Cat?
ID # of the Pet:
Name of the Pet:
Name:
Address:
City:
State:
Zip Code:
Home Phone:
Cell Phone:
Work Phone:
Email:
Drivers
License/ID #:
Drivers
License/ID Expiration Date:
Date of Birth
(MM/DD/YYYY):
Reason(s) why you
are considering adoption.
Please be specific:
Do you currently
live in a:
Do you?:
Landlord's Name
and Telephone Number:
Who are You
adopting this Pet for?
If you suddenly
had to give up this pet for any
reason, what would you do with this animal?
If your new pet
were to become seriously injured
or ill and needed expensive veterinary care, what would you do?
What veterinarian
will you be using for this pet?
Are you willing
to have this animal
spayed/neutered? Yes or No?
If you are not
willing to have the animal
spayed/neutered, why?
How many people
live in your household?
Number of
children (please list ages of children):
Does anyone in
your household have allergies to
animals? Yes or No?
Have you ever had
to release an animal to an
animal shelter? If yes, Please explain:
Are you familiar
with Animal Control Laws
regarding licenses? Yes or No?
Have you ever
adopted from an animal shelter or
rescue? If so, which organization:
Please provide
the following information for all
pets (DOGS and CATS) you currently own or have owned in the past: Name,
Breed, Age, Sex, Spayed/Neutered, How long did you own?, What happened
to this Pet?
If you have a
fenced yard, what type of fence?
Height of fence?
FOR DOGS ONLY.
How will you keep this pet
confined to your yard?
This Pet will be
kept:
FOR CATS ONLY.
If you are not applying for a Cat, Please mark the "Not Applicable" Box.
Please list two
references that live closest to
you (Friend or Relative, etc.) Please provide Name, Address and Phone
Number:
I have read and
understand the Pet Adoption
Program guidelines of The Humane Society of Cowlitz County. I agree to
abide by these guidelines. I also realize there are NO REFUNDS for
adoptions, unless a vet performs the 72 hour vet exam and the animal is
ill. By signing below I understand The Humane Society of Cowlitz County
is not responsible for any veterinarian bills except for a portion of
the spay/neuter surgery. Please sign and date here:
PAYMENT
INFORMATION. How will you be paying for
this adoption?
Type of Credit
Card?
Credit Card
Number:
Credit Card
Expiration Date:
Three Digit
Security Code (on back of the card):
The Humane
Society will pay for a PORTION of the
spay/neuter fee to the Veterinarian of your choice. Please initial here:
There will be a
balance to pay your Veterinarian
for this surgery and any additional services you request. Please
initial here:
You will be
responsible for any other charges.
Please initial here:
We can call your
Veterinarian and ask what the
approximate balance will be. Please initial here:
ATTENTION
ADOPTERS: The Humane Society of Cowlitz
County can not, and will not, be responsible for disease or sickness
transferred to any pet at your home from this adopted pet. Nor is the
Humane Society of Cowlitz County responsible if your pet, already at
home, has a disease or sickness that gets this adopted pet sick.
We advise your newly adopted pet not to come in contact with any other
pet in your household for 14 days after adoption. Please initial:
I have read and
understand the above information:
Please initial here:
IMPORTANT
INFORMATION: Please read and initial:
Your new pet has received initial vaccinations at the Humane Society.
Your veterinarian will prescribe further boosters and vaccinations as
they are necessary. Inside your adoption folder is information about
when and what vaccinations have been given. Please take the information
with you to show your veterinarian.
Please read and
initial: Your new pet has an
implanted microchip. This microchip has a unique number that we have
listed at the Humane Society with your name, address and phone number.
You can also register your name, address and phone number with the
microchip company, AVID. Call 1-800-336-2843 to register. You will need
to inform the Humane Society and AVID, anytime that your information
changes, or it will not help get your pet returned to you.
Please read and
initial: The Humane Society
appreciates the client-veterinarian relationship and encourages you to
use the veterinarian of your choice for the spay/neuter operation. Some
veterinarians will charge an additional amount for surgery. This amount
will vary by size, sex and species of the animal. The Humane Society is
more than willing to have you call you veterinarian from the Shelter to
discuss the price of surgery for your new pet.
FOR OFFICE USE
ONLY: Date Application Accepted:
Time:
Approved by:
Landlord Approved:
Vet Appointment
Date:
Notes:
