Please answer all questions as thoroughly as possible:
The animal I am interested in adopting is:
If renting; Landlord's name, address, and telephone number:
Please list 2 personal references, (name, address, and phone #)
Why do you want this animal?
In order to care for this animal I have researched its care by:
Please list any books you have read on the subject or any periodicals you
Do you own other pets of this species?
If so, please list age, sex and how long you have owned it:
Where will this pet be kept?
Are you adopting this pet for:
How many adults live in your household?
What are the children's ages?
Do you plan on breeding the animal?
Do you know how long this animal is likely to live?
Are you willing to care for it for the rest of its life?
Does anyone in your household have allergies of any kind?
Who is your veterinarian?
Does your veterinarian care for this kind of animal?
Do you object to the Humane Society visiting your pet?
Answer the following for farm animals only:
What type of housing/shelter do you have?
Please write complete and accurate directions to your house:
How will you confine this animal to your property?
Please list all the pets you have owned in the past five years:
Where did you get the pets you have now?
Have you ever brought an animal to a shelter before?
I CERTIFY THAT THE ABOVE IS TRUE AND THAT ANY FALSE INFORMATION MAY RESULT
IN NULLIFYING THIS ADOPTION. I FURTHER UNDERSTAND THAT THIS APPLICATION IS
THE PEOPERTY OF THE COCHECO VALLEY HUMANE SOCIETY AND WILL BE RETAINED BY THEM.