HUMANE SOCIETY OF MONROE COUNTY MEMBERSHIP APPLICATION

 

APPLICATION FOR ADOPTION

The following information is requested so that we can help you choose an animal that will fit your home and lifestyle as a lifetime companion.  The animal’s welfare is our foremost consideration. 


The animals available for adoption here are from a variety of sources.  All animals are examined upon entry, and their health is monitored while with us, but there is always a chance that an animal is incubating a disease without showing any clinical signs.

IN ORDER TO BE CONSIDERED AS AN ADOPTER, YOU MUST:

                .  Be 18 years of age or older,
                .  Have identification showing your present address,
                .  Have the knowledge and consent of your landlord
                .  Be able and willing to spend the time and money necessary to provide veterinary care and treatment, proper nutrition,  exercise, training (as needed) and proper pet care.

NAME _____________________________________ E-MAIL ___________________________

ADDRESS _________________________________________________________________________

CITY ______________________________________________   STATE ________ ZIP __________

HOME PHONE  ____________________WORK or CELL PHONE ________________________

The Humane Society of Monroe County, IL reserves the right to refuse adoption to anyone.  No animal(s) will be adopted to prospective owners who mislead or fail to provide accurate information on this Application for Adoption.

PLEASE FILL OUT BOTH SIDES OF THIS QUESTIONNAIRE TO BE REVIEWED FOR POSSIBLE PET ADOPTION.

I am interested in a specific pet.  o Puppy/Dog   o Kitten/Cat      Pet’s Name__________________

How did you hear about this pet? ____________________________________________________________

1.    What kind of pet are you here to adopt?  o Puppy   o Adult Dog   o Kitten  o Adult Cat   Other _____________

2.       Why do you want a pet? __________________________________________________________________

3.       Do you have any preferences as to breed type, sex, age, size, length of hair, etc.? ______________________

    ________________________________________________________________________________________

4.       Is this your first experience with a pet?    o Yes    o No

5.    Have you ever had a pet before?  o Yes  o No.    If yes, when ______ from where ____________________

       Do you still have this pet?  o Yes  o No   If not, what happened to this pet? __________________________

6.       What pets do you currently have in your household?

                                                                  TYPE            SPAYED/NEUTERED     KEPT WHERE?          AGE

        Name ________________    o Dog o Cat         o Yes  o  No               o In  o Out        ________

Name ________________    o Dog  o Cat        o Yes  o  No               o  In  o Out        ________

Name ________________    o Dog  o Cat       o Yes  o  No                o  In  o Out        ________

Name ________________    o Dog  o Cat       o Yes  o  No                o  In  o Out        ________

Name ________________    o Dog  o Cat        o Yes  o  No               o  In  o Out        ________

Name ________________    o Dog  o Cat        o Yes  o  No               o  In  o Out        ________

7.       Who is your veterinarian? _______________________________________Phone_____________________

8.       Do you currently live in a   o house    o  apartment    o condo  o  mobile home  o duplex?    

9.       Do you     o own     or   o rent?

10.   If you rent, does your lease allow pets? o Yes    o No

11.   If you rent, what is your landlord’s name? _____________________________Phone?__________________

12.   How long have you lived at the above address? ________________________________________________

13.   How many people live in your household? ____  Adults ____ Children   Ages _______________

14.   Do all the adults know that you plan to adopt?  o Yes  o No

15.   Do you or does anyone living in your household have any known allergies to animals? o Yes  o No

       If yes, to what kind(s) of animals and how severe is the allergy? ___________________________________

16.   Who will be responsible for the care of this pet?  _______________________________________________

17.   Where will this pet be kept during the day? __________________________ night? ____________________

18.   How many hours per day will this pet be alone on a regular basis? o  0-3  o 3-6 o 6-9 o 9-12 o more than 12

19.   Where will it be kept when alone? ___________________________________________________________

20.   Do you plan on spaying (female) or neutering (male) your pet?  o Yes     o No

 

DOG ADOPTIONS ONLY

21.   Do you want this dog for a: (check all that apply)

        o House pet       o Guard Dog     o Watch Dog      o Companion      o Gift      o Company for other pet(s)

o Other (please explain) ___________________________________________________________________

22.  Where will this dog be kept?   o Indoors    o Outdoors    o Both     How long outdoors? _____________________

22.   How will this dog be confined when outdoors?  o Fence?  If so, what kind & how high? ________________

o Kennel?  If so, how high? ________  o  Chained?  o Leashed?  If chained/leashed, on a run? o Yes  o No  Supervised?  o Yes  o No

23.  Do you realize you will probably have to housetrain your new puppy or dog?  ? Yes    ?  No.  Would you like information on how to housetrain a new puppy or dog?   o Yes    o  No

24.   What are you prepared to do if your puppy/dog chews furniture or shows other destructive behavior(s)? _______________________________________________________________________________________

25.   Are you familiar with crating?   o Yes   o  No.      If so, what are your feelings about it? _______________________________________________________________________________________

26.   Are you familiar with heartworm disease?  o Yes o No.  If so, are you willing to spend the money to                    

protect your pet against heartworm disease?  o Yes   o No

 

 CAT  ADOPTIONS ONLY

27.   Do you want the cat for a:  (check all that apply)

o House Pet   o Mouser  o Breeder  o Companion  o Gift  o Company for another pet  o Other (explain)     _______________________________________________________________________________________

28.   Will this kitten/cat be allowed outdoors?  o Yes  o  No  If yes, under what circumstances? ______________

_______________________________________________________________________________________

29.   Do you plan to have this cat declawed?   o Yes    o  No     If so, do you realize that you can not let this cat outdoors without supervision since it has no way of defending itself?    o Yes   o No

30.   What will you do if your cat claws furniture or shows other destructive behavior(s)? ___________________


____________________________________

Signature

_____________________________________

Date

Call when you complete this application to schedule a visit:  (618) 282-PETS (7387)  

Thank you for providing this information.  Your application, along with others for this pet, will be reviewed and this pet will be placed in, what HSMC feels, is the best possible home.

Web Site: www.hsofmcil.org.  Phone (618) 282-PETS (7387).

Revised June 19, 2008
Page design by Mechelle Childers
Copyright @ 2006 Humane Society of Monroe County.
 
Home