Adoption Application

In order to be eligible for the adoption of our animals, the applicant must:

Be at least 18 years old
Have a valid government issued photo ID and valid proof of current address
Have knowledge and consent of all adults living in their household
Have landlord consent to bring an animal onto the property (if renting)
Provide consent to veterinarian recommendation (where applicable)
Pass a background check
Understand that the Humane Society of Cambria County reserves the right to refuse the adoption of any animal to any individual

Background Information

First Name: *

Last Name: *

Address: *

City: *

State: *

Zip Code: *

County of Residence: *

Phone: *

Email Address:

Which animal are you interested in adopting? *

If the animal of your interest is adopted, do you want pre-qualified? Your application will be kept on file for 6 months and be eligible for other adoptable animals. *

How did you learn about this animal? *

If other, please specify:

Employer Name:

Employer Phone:

If not employed, what is your source of income?

Have you ever been convicted of a felony or incarcerated in connection with a felony? *

If yes, please explain:

Household Information

Number of adults in household: *

Number of children in household: *

Age of children (if applicable):

Please list all household members over the age of 18:

Adopter Information (Your Information)

Name: *

Birthdate: *

Maiden Name/Aliases:

Household Member 1 Information

Name:

Relationship:

Birthdate:

Maiden Name/Aliases:

Household Member 2 Information

Name:

Relationship:

Birthdate:

Maiden Name/Aliases:

Household Member 3 Information

Name:

Relationship:

Birthdate:

Maiden Name/Aliases:

Additional Household Member(s) Information

If there are additional household members over the age of 18 who are not listed above, please list their name(s) including maiden name(s) & alias(es), your relationship(s), and birthday(s):

How long have you lived at your current address? *

If less than 5 years, what was your previous address?

What are your current living arrangements? *

If other, please explain:

If renting, please provide your landlord's contact information.

Name:

Phone:

Address:

References

Reference 1 Information

Name: *

Phone: *

Relationship: *

Reference 2 Information

Name: *

Phone: *

Relationship *

Reference 3 Information

Name: *

Phone: *

Relationship: *

Animal Background

How many pets are currently living in your household?

Dogs: *

Cats: *

Other: *

If other, please specify:

Tell us about your pets:

Pet 1 Information

Type of Pet:

Pet Name:

Is this pet current on licensing and vaccinations?

Is this pet spayed/neutered?

Sex of Pet:

Pet 2 Information

Type of Pet:

Pet Name:

Is this pet current on licensing and vaccinations?

Is this pet spayed/neutered?

Sex of Pet:

Pet 3 Information

Type of Pet:

Pet Name:

Is this pet current on licensing and vaccinations?

Is this pet spayed/neutered?

Sex of Pet:

Pet 4 Information

Type of Pet:

Pet Name:

Is this pet current on licensing and vaccinations?

Is this pet spayed/neutered?

Sex of Pet:

Additional Pet Information

If you have additional pets in the home who are not listed above, please list their type(s), name(s), licensing & vaccination status(es), spay/neuter status(es), and sex(es):

Who is/are your veterinarian(s)? *

If other, please specify

Vet phone number(s) if outside Cambria County:

Do you authorize the release of your complete pet(s) medical records from your veterinarian(s) office? *

Why do you wish to adopt a pet? Check all that apply: *

If other, please describe:

Where do you plan on keeping this pet? *

Have you ever adopted or fostered a pet from a shelter or rescue? *

If yes, where did you adopt from and where is the pet now?

Have you ever given up a pet for any reason? *

If yes, what pet and why? When did this happen and where is the pet now?

Are you willing to work through unexpected behaviors and consult an animal professional if necessary? *

What pet behaviors are unacceptable, and how do you plan to correct? How long are you willing to allow your new pet to adjust to his/her new home? *

Are you willing to make the appropriate accommodations for a new pet? *

How many hours will your pet be alone, and where will he/she stay during this time? What type of exercise will your pet receive, and how often? *

Agreement

By entering my name below, I understand that I have provided consent to the Humane Society of Cambria County to obtain my personal information needed to process my application. I am agreeing that I believe I am capable of caring for and providing for the pet that I propose to adopt. I believe that I am financially responsible to meet the needs for the pet that I propose to adopt. I have answered the questions above truthfully and to the best of my ability. I understand that any misrepresentation of the information provided above is grounds for the denial of any adoption. I understand that even upon completion of this application, I am not guaranteed to be approved for the adoption of the proposed pet and that the Humane Society of Cambria County reserves the right to deny any adoption.

Electronic Signature: *

Date: *