Adoption Application Home » Adoption Application If you would prefer to download a PDF version of the application, you may do so here » "*" indicates required fields Personal InformationName* First Last Address* Street Address Address Line 2 City State / ProvinceAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Do you:* Own Rent (Permission of landlord is required) Landlord First and Last Name*Landlord Phone Number*Do you live in:* House Mobile Home Apartment Live with Parents Other Please provide details of ("other") where you live:*Email* Age*Please select oneUnder 2121-2425-3435-4445-5455-6465 or AbovePrimary Phone*Secondary PhoneDriver's License Number*State*PennsylvaniaAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificDate of Birth* Month Day Year Employment StatusEmployment Status*Please select oneEmployed Full-TimeEmployed Part-TimeUnemployedRetiredEmployerEmployer PhoneAdoption InterestType of Animal*Please select oneDogCatNameAgeSexPlease select oneMaleFemaleColorIntake NumberDo you now or have you ever owned a pet?* Yes No Pet Ownership HistoryTypePlease select oneDogCatOtherNameAgePlease select one1234567891011121314151617181920SexPlease select oneMaleFemaleSpayed / NeuteredPlease select oneYesNoTime OwnedWhat Happened?Add a 2nd Animal? Yes I'm done entering Animals TypePlease select oneDogCatOtherNameAgePlease select one1234567891011121314151617181920SexPlease select oneMaleFemaleSpayed / NeuteredPlease select oneYesNoTime OwnedWhat Happened?Add a 3rd Animal? Yes I'm done entering animals TypePlease select oneDogCatOtherNameAgePlease select one1234567891011121314151617181920SexPlease select oneMaleFemaleSpayed / NeuteredPlease select oneYesNoTime OwnedWhat Happened?Any more animals that should be listed? Yes I'm done entering animals Other Animal DetailsPlease list: Animal Type – Name – Age – Sex – Spayed/Neutered – Time Owned – What Happened To PetVeterinarian ReferenceClinic / Veterinarian Name*Phone*Date of Last Vet Visit Month Day Year Family member under which your pet(s) are registeredAre your pets spayed / neutered?Please select oneYesNoCurrent on vaccinations?Please select oneYesNoIf you have a dog, is it licensed?Please select oneYesNoMay we call your veterinarian and ask how you care for your animals?Please select oneYesNoPlease call your vet to let them know that we may be calling!Are there any other details we should know regarding your current pets veterinarian care?Personal ReferencesPlease provide three non-relatives as personal references along with phone numbers. Please do not list relatives or people living with youName 1*Phone*Address*Relationship*Name 2*Phone*Address*Relationship*Name 3*Phone*Address*Relationship*Adoption InterviewHave you ever adopted an animal from us?* Yes No Have you ever applied to us for an animal?* Yes No Why do you want to adopt this animal?* Companion Company for other pet Gift For Children Other How many adults live in your home?*Please select one12345678910How many children live in your home?*Please select one012345678910What are the ages of your children?*List ages, separated by a comma, if more than one.Do you have a significant other?* Yes No Significant other's name?*How do they feel about adopting a pet?*How long have you lived at your current residence?*How many times have you moved in the past 5 years?*If you move in the future, what will you do with your pet?*Who will be primarily responsible for this animal?*Where will your dog live?* Indoors Outdoors Where will your cat live?* Indoors Outdoors Is your current cat declawed?* Yes No I don't currently have a cat Will your new cat be declawed?* Yes No Do you have a fenced yard?* Yes No Describe the fence.*Please attach photos of the fence if possible. Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 100 MB, Max. files: 5. How many hours will this pet be alone per day?*Where will this pet be kept during the day?*If you go on vacation or in an emergency, who will care for the pet?*All pets adopted must be spayed or neutered to prevent the births of more unwanted dogs and cats. How do you feel about this?*How much do you think it will cost to care for, vaccinate and license this animal each year?*How many years do you expect to take responsibility for this pet?*How much time would you allow your new pet to adjust to your family and/or present pets?*Are you familiar with local animal ordinances?* Yes No Have you ever been convicted of a violent crime or sexual assault or have you ever had a “Protection From Abuse Order” entered against you?* Yes No AffirmationI hereby affirm that all the above information is true and correct. I understand that submissions of this application does not necessarily mean that I will be approved to adopt and that the Humane Society of Greene County reserves the right to reject any applicant. I authorize you to verify any and all information set forth in this application and contact my personal references.*Date of Submission* Month Day Year Standards for AdoptionRead the Standards for Adoption here.I agree to the conditions and wish to adopt a petApplicant’s Digital Signature*Date* Month Day Year PhoneThis field is for validation purposes and should be left unchanged. Δ
