Pet Adoption Application | Humane Society for Hamilton County

TELL US ABOUT YOURSELF
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Driver's License Number*
Date of Birth*
Month
Day
Year
Cell/Other Phone*
Home Phone
Optional
Work Phone
Optional
Occupation:*
Emergency Contact*
Please, list someone other than yourself.
First Last
Emergency Contact Phone*
Are you at least 18 years of age?*
- Yes
- No
How did you hear about the shelter or the animal you'd like to adopt?*
Please Explain:*

Areas of Interest
I am interested in adopting a:*
- Cat
- Specific Cat
- Dog
- Specific Dog
- Either
Name of the cat or dog you'd like to adopt.*

TELL US ABOUT YOUR FAMILY & VISITORS
Please tell us about your current household*
- Live Alone
- Adults Only
- Family with children
Please, list the ages of all individuals living in your home including yourself.*
Click the "+" on the right of the row to add additional rows.
Age
Is any member of your household allergic to animals?*
- Yes
- No
If yes, they are allergic to:*
- Cats
- Dogs
- Both
Do you have visitors often?*
- Yes
- No
What is the frequency of visitors in your home?*
e.g. Babysitters, Nannies, Extended Family, Significant Others, Neighbors, Friends, etc.
Are there children/grandchildren who visit your home REGARDLESS OF FREQUENCY?*
Anyone under the age of 18 is considered a child.
- Yes
- No
Please, list ages of each child that visits and how often they visit.*
Age Visit Frequency
Do you anticipate the addition of new household members in the near future?
New baby, Parents/Siblings moving in, Roommates
- Yes
- No
The activity level in your home is*
- Quiet
- Active
- Very Active

TELL US ABOUT YOUR PETS
Do you currently have any pets?*
- Yes
- No
Current Pets*
Breed/Mix Sex (M or F) Age Spayed/Neutered? (Yes or No) Length Owned?
Name of your Veterinarian Or Clinic*
Please put "N/A" if not applicable
Veterinarian's Phone
If one of your current pets is not spayed/neutered, please explain why.*
Please put "N/A" if not applicable
If one of your current pets is not current on vaccines, please explain why.*
Please put "N/A" if not applicable

Please tell us about your PAST pets (adult life only - past 10 years).
Have you ever surrendered or rehomed a personal pet to this or any other shelter/rescue group?*
- Yes
- No
Please, explain.*
In the past 10 years, have you had any pets you no longer own (e.g. passed away, rehomed, run away)?*
This does not include pets your parents owned when you were under 18 years of age.
- Yes
- No
Past Pets (adult life only - past 10 years)*
Breed/Mix Sex (M or F) Spayed/ Neutered? (Yes or no) Length Owned? What Happened? (e.g. Died, Rehomed) Age at Death, Rehoming, Etc.
Planning Ahead
Owning a pet, at a MINIMUM, can be a 10 year commitment.*
Do you have any questions or concerns with this time commitment?
- No
- Yes
If yes, please explain:*
The average annual budget to provide basic care for a pet is estimated at $1,500/year, not including medical issues that may arise.*
Do you have any questions or concerns with this financial commitment?
- No
- Yes
If yes, please explain:*
Are you planning to move or change jobs in the next 3-6 months?*
- Yes
- No
Please explain what will happen with your new pet at that time.
Next Steps!
We appreciate your time and interest in adopting a pet from us. Please note that the purpose of this application is to learn more about you so that we can match you and your family with the right, life-long pet. THE NEXT STEP is for you to come visit us so we can discuss and then introduce you to possible candidates. We will keep your application on file for 6 months. By signing below, you acknowledge this is not the approval or guarantee of a pet adoption from our facility, but rather, the first step in helping us match you with the perfect pet.
Signature*
Please type your legal name.

Adoption Application

Step 1 of 7

TELL US ABOUT YOURSELF

Areas of Interest

TELL US ABOUT YOUR HOUSEHOLD

TELL US ABOUT YOUR FAMILY & VISITORS

Matchmaking Questions

TELL US ABOUT YOUR PETS

Please tell us about your PAST pets (adult life only - past 10 years).

Planning Ahead

Next Steps!

Breed/Mix	Sex (M or F)	Age	Spayed/Neutered? (Yes or No)	Length Owned?

Breed/Mix	Sex (M or F)	Spayed/ Neutered? (Yes or no)	Length Owned?	What Happened? (e.g. Died, Rehomed)	Age at Death, Rehoming, Etc.

Age	Visit Frequency