*Attention!  Please fill out the application in its entirety or we cannot process it. Also, please verify any phone numbers that you provide for accuracy or we will be unable to contact you. Finally, please include all Vet information for past (that you have owned in the last 10 years) or current pets and Veterinarians including Vet name and phone number, the names of all the animals (from the last 10 years) and the name that the account is under if it has changed.

*Perry County Humane Society has a 100 mile adoption radius.  If you are unable to keep your pets for any reason you would be required by law to return them to PCHS.  In the past we have had issues with animals not being returned due to distance and they have been unnecessarily euthanized. Unfortunately 64% of all animals that end up at shelters are put to sleep for lack of homes. We are certain that you will be successful in reducing that percentage by adopting from a shelter near you. Thank you for choosing to adopt and not furthering the cycle of pet overpopulation through puppy and kitten mills.

Name of Animal Interested in Adopting:
 
Your Information:
1. Name of applicant
2. Date of application
3 Applicant's age
4 Marital Status
Married
Not Married
5. Street address
6. City
7. State
8. Zip
9. Daytime number at which you can be reached
10. Evening phone
11. Employer
12. Spouse employer
13. Email address
14. Number of adults in household
15. Number of children in household and ages
16. Is anyone in the household allergic to cats or dogs?
17. Who will have the feeding responsibility?
18. Who will have the training responsibility?
19. What concerns if any does your family have about adopting a new pet?
20. How long have you been considering a new pet?
21. Do children visit? (If yes, please list ages)
22. Are you expecting or planning a family?
23. What steps will you take to ensure your child(ren) are educated in pet ownership and proper pet care and interaction?
24. Type of dwelling:
House
Apartment
Trailer
Condo
Duplex
Other
25. How long have you lived at this residence?
26. Landlord name and phone number and name under which lease is listed if renting? *
27. If you move what will you do with your pets?
28. Under what circumstances would you NOT keep your pets?
29. Would you be willing to let us visit your home?
30. Pets can take up to a month to adjust to their new homes particularly if other pets are involved. Are you willing to devote this much time?
31. What makes you a good pet owner?
32. Have you ever applied with another Rescue/Shelter if so which one(s)?
33. If you are a first time pet owner please provide us with a brief explanation why you have not owned pets and now want to adopt. As well as list 3 personal references including the references’ phone numbers.
 
Dog Applicants: (If you are applying for a cat please skip this section)
1. How large is your yard (Approximately)?
2. Is it securely fenced?
3. If yes, what kind and how tall?
4. If no, will you fence it if you get a dog?
5. If your yard is not fenced how do you plan to ensure that the dog receives safe and adequate exercise?
6. Will you be able to devote daily time to adequately walk your pet for proper exercise?
7. Would you say your activity level is high, moderate or low?
8. Do you plan to keep the animal primarily outdoors or in (Please be specific)?
9. Where will the animal be kept during the day (Please be specific)?
10. Where would your animal be kept at night or sleep (Please be specific)?
11. Do you plan to crate your animal? (Why or why not)
12. Generally speaking what kind of temperament are you looking for in a pet?
13. What amount of effort per week will you devote to training your pet?
14. What are your training objectives?
15. Are you likely to enroll them in obedience class?
16. Which family members would assist with home training?
17. What is your definition of disciplining your dog?
18. How do you plan to deal with behavior issues such as:
 
Barking
Jumping
Chewing
Digging
Growling or Snapping  (Not Biting)
Aggressive Behavior
19. How do you plan to housebreak your pet?
20. Describe how your pet would spend the day
 
Cat Applicants: (If you are applying for a dog please skip this section)
1. Do you plan to keep the animal primarily outdoors or in (Please be specific)?
2. Where will the animal be kept during the day (Please be specific)?
3. Where would your animal be kept at night or sleep (Please be specific)?
4. What sort of discipline would you use for problem behaviors?
5. Generally speaking what kind of temperament are you looking for in a pet?
6. What amount of effort per week will you devote to training your pet?
7. What are your training objectives?
8. Which family members would assist with in home training?
9. How do you plan to deal with behavior issues such as:
 
Chewing
Scratching
Hissing
Spraying
10. How do you plan to housebreak your pet?
11. Describe how your pet would spend the day
 
Current Pet History:
1. List all pets you currently own
2. Breed(s)
3. Sex(es)
4. Age(s)
5. Spayed or neutered, if no please explain
6. Are your pet(s) kept indoors or outdoors?
7. Where did you get this pet(s)?
8. What activities do you participate in with your pet(s)?
9. What brand of food do you feed your pet(s)?
10. What type of flea control do you use on your pet(s)?
11. When no one is home where does your pet(s) stay?
12. Do you consider your current pet(s) aggressive to other animals or people?
13. What type of heartworm preventative do you give your dog?
14. Have you attended obedience class with your dog?
15. Have your cat(s) been tested for disease such as feline leukemia and feline aids?
 
Previous Pet History (Please list any and all pets you have owned in the last 10 years):
If you have animals past the 10 year mark that are listed on your current vets account please list them so that when we call to verify your previous pets with your vet there is no confusion.
1. Pets(s) name and breed(s)
2. How long did you have your pet(s)?
3. Was your pet kept indoors or outdoors?
4. Spayed or neutered, if no please explain
5. Where is pet now (if deceased cause of death)?
6. Where did you get this pet(s)?
7. What activities did you participate in with your pet (s)?
8. What brand of food did you feed your pet(s)?
9. What type of flea control did you use on your pet(s)?
10. When no one is home where did your pet(s) stay?
11. Do you consider your previous pet(s) aggressive to other animals or people?
12. What type of heartworm preventative did you give your dog?
13. Did you attend obedience class with your dog?
14. Were your cat(s) tested for disease such as feline leukemia and feline aids?
15. Have you ever given up a pet(s)? If yes, please explain in detail?
 
Care and Veterinary Information:
1. What brand of food will you feed your new pet?
2. Your annual estimated cost of food for your new pet?
3. Will you be willing to take your new pet to the Groomer if needed?
4. Your annual estimated cost of grooming your new pet?
5. Will you agree to keep your pet on heartworm preventative (for dogs) and flea preventative (for dogs and cats)?
6. Will you agree to keep your pet up-to-date on all required routine vaccinations?
7. Your annual estimated cost of routine Veterinary care for your new pet?
8. What would you do if emergency or general medical care exceeded one thousand dollars?
9. Please list your current Vet’s information including name, phone number, address and the name the account was held under.
10. Please list your previous Vet’s information including name, phone number, address and the name the account was held under.
*Please note, if Veterinary information is not provided your application will not be processed!  Without a vaccination and/or spay and neuter history for your pet we will be unable to verify your pets medical history.  If you have changed Vets at any time while owning your current pets or previous pets please make sure that you list previous Vetting information.
I the undersigned attest the above information is accurate and complete at the time of signing. I understand that falsely providing information can mean that my application will be denied. I understand that by typing my name I am signing this document. Please sign and date.
 
Thank you for your cooperation and completing this comprehensive application and questionnaire in its entirety. This questionnaire allows us to place the right dog or cat with the right family in a forever loving home. An improper placement or one in which not all details are disclosed can end tragically, usually at your new pets expense.
 
Please be aware that submission of an application does not guarantee that your application will be approved. We have guidelines that we must adhere to in order to provide the best possible homes for all of our pets. We will contact you within 2-3 business days after we have had a chance to review your application and follow up with your references. You should receive an automatic response within 24 hours after the submission of your application to verify receipt and with instructions on what happens next.
 
Thank you!
Perry County Humane Society