Pre-Screening Adoption Application

This application does not commit you to an adoption. It is used to screen those interested in adopting.

We at the Humane Society are trying to place our animals in permanent, responsible homes, while at the same time, match you with a pet that is suitable for you and your lifestyle.

This application must be completed by anyone interested in adopting a pet from the Humane Society.

Note: Providing false information anywhere on this application will result in you not being approved and/or the forfeiture of all fees and animal(s) adopted.
(YOU MUST COMPLETE ALL QUESTIONS ON THIS APPLICATION IN ORDER TO ADOPT)

Your first name and middle initial: *
Your last name: *
Your physical address: *
City you reside in: *
State you reside in: *
Zipcode for your area: *
Your home phone #:
Your work phone #:
Your cell phone #: *
Your e-mail address:
Are you 18 years of age or older? *
Please upload a picture of your driver's license: *
What are you interested in adopting? *	Cat Dog Other
Is there a specific pet you are interested in adopting? If you are not sure, please leave blank.
Why are you adopting a pet? *
Do you rent? *
The Humane Society's (HSCC) policy requires the adopter to provide documentation of Landlord's approval for a pet (or pets) on the premises, that any required pet deposits have been paid, and that adopted pet is within imposed breed and size restrictions.
Enter landlord's name and telephone number: *
Are there children in the home? *
What are the ages of any/all children in your home? *
Have you ever turned in a pet to the Humane Society of Camden County? *
If yes, please explain when and why: *
Are there current pets in your household? *
As to the current pets in your household, list each pets name, age, sex, breed: *
Are the pets in your household up to date on all of their shots? *
If no, please explain: *
Are the pets in your household spayed or neutered? *
If no, please explain: *
What is the name of your Veterinarian or Veterinary Clinic? *
Are you willing to go to the expense of taking your pet to the veterinarian for full preventative and medical care at least once a year? *
Is there a yard available at your residence? *
If so, is it completely fenced in? *
Is there adequate shelter available for your dog/puppy? *
Will your puppy/dog ever be chained or tied? *
If adopting a kitten/cat, how will you handle scratching or destructive behavior? *
Has a cat died on your premises of distemper, leukemia, feline aids, or any other causes within the last six months? *
If yes, please explain: *
Has a dog died on your premises of parvo, distemper, heartworms, or any other causes within the last six months? *
If yes, please explain: *
E-Signature: *
Today's Date: *
Notice Concerning Spay/Neuter Fees It has been brought to the Humane Society's (HSCC) attention that a few of the area veterinarians, who have agreements with the HSCC, mandate certain additional procedures that other area veterinarians do not require when performing spay/neuters. These additional mandated procedures are not covered in the HSCC's spay/neuter agreement with the veterinarians and; therefore, are not included in the HSCC spay/neuter fee. Prior to the spay/neuter procedure being performed by your selected veterinarian, it is important that you ask him/her for an itemized list of all procedures/costs to be preformed, as you will be responsible for payment to the veterinarian for any additional procedures. The HSCC adoption price and spay/neuter procedure includes the following: Dogs $85 \| Puppies/Small or Purebreds $155 Health Exam Routine Spay/Neuter 1 night boarding 24-hour pain management Intravenous fluids, if indicated Rabies vaccination Fecal Exam (HSCC) Heartworm tests (HSCC) Cats/Kittens $60 Health Exam Routine Spay/Neuter 1 night boarding 24-hour pain management Intravenous fluids, if indicated Rabies vaccination FIV/FELV test (HSCC)
E-Signature: *
Today's Date: *
HSCC Partnered Veterinarian List The HSCC is proud to be partnered with the following veterinarians list below. If the vet you select cannot spay/neuter your pet within a reasonable time, an HSCC staff member will advise you accordingly and another vet shall be selected. HSCC staff members are not permitted to make vet recommendations. NOTE: Only the vets listed below are authorized to perform spay/neuters on HSCC adopted animals.
Please select the vet you would prefer to spay/neuter your pet: *