Adoption Application

For a printable version of this application, please click here.

PLEASE READ CAREFULLY!!

Thank you for taking the time to fill out our questionnaire. The purpose of this application is to learn a little about your family and home so our organization can make the best possible match for both you and our rescue animal. Our main concern is placing our animals in a compatible home with a family that will give them a LIFETIME commitment of love and proper care. This consultation process is designed to help us determine if the adoption is in the best interest of both the animal and the adopter. Please be aware that while completing this application does not bind you to adopt one of our animals, neither does it guarantee that we will place one of our animals in your home at this time. If you are interested in learning more about one of our shelter animals, please answer the questions honestly and thoroughly.

Some animals may need extra time and patience to adjust to yet another new home. Some may need house training or other types of training and some may just need a little extra time and understanding. All animals regardless of their background and history go through an adjustment period when they go into a new environment. There will be a period of a few days, weeks or in some cases months during which your new pet’s personality is emerging and growing while you get to know one another. Please remember that this is a stressful time for an animal and hopefully we will be able to work together to make this a lifetime relationship for you and your rescued pet. You can call on us at any time to help you in any way. With this in mind, please answer the questions on the application to the best of your ability.

We reserve the right to refuse adoption to anyone for any reason. A represented of our group may conduct a home visit prior to the following adoption and our group has the right to reclaim an animal following an adoption if unsuitable home conditions, evidence of neglect, abuse or other mistreatment of an animal are establish.

IN ORDER TO BE CONSIDERED AS AN ADOPTER YOU MUST:
• Be 21 years of age or older.
• Having identification showing your present address.
• Have the knowledge and consent of your landlord.
• Be willing to have a rescue representative visit your home by appointment.
• Be able and willing to spend the time and financial resources to provide training, medical treatment and quality care for the life of this animal.

Online Application

All information must be completed in order to be considered for adoption. Marion Grant County Humane Society (MGCHS) does NOT adopt out to owners who do NOT provide monthly heart worm preventative, yearly vaccinations, and have unaltered animals. Medical conditions are the ONLY exception for unaltered animals and MUST be supported by veterinary records.

Pet Information

Date*

Dog or Cat Adoption?*

Animal Name*

Male or Female?

Breed?

If Cat, Describe color/marking and which room

Contact Information

Full Name*

Age*

Street Address*

City*

State*

Zip Code*

Contact Phone*

Email Address*

Best Time to Conact You*

Place of Employment

Hours Worked Per Day?

How Long Have You Worked There?

Work Phone

Family And Dwelling Information

Marion Grant County Humane Society (MGCHS) reserves the right for periodic home checks.

Names and ages of all adults living in the residence:*

Names and ages of all children living in the residence:*

Do you own or rent?*

How long have you lived at this location?*

What type of dwelling do you live in?*

Describe your fenced yard; type, height, location from house:*

If you rent, what is your Landlord’s Name, Address and Phone Number?

Will you allow a MGCHS representative to do a home check to verify suitable accommodations are being met?*

Please answer all questions and click Submit to send your application to the Humane Society.

Pet Care and History

How often will you walk the animal?*

How long will the animal be left alone each day?*

Will this be an inside or outside animal?*

If you are adopting a cat, will it be strictly an inside animal?

Please list the pets you have owned in the last 5 years. (Species, Breed, Sex, Name)*

Please explain where the pet is now, if it is not living with you:*

Are all of your pets residing with you up to date on vaccinations and medical check-ups? If NO, please explain the reason.*

Are all of the pets residing with you spayed/neutered? If NO, please explain the reason.*

References and Veterinarian Contact

Who is/was your veterinarian?*

Your Veterinary Clinic Name, Address and Phone number*

Years you have been with your vet?*

Personal Reference #1

Full Name*

Phone Number*

Personal Reference #2

Full Name*

Phone Number*

Personal Reference #3

Full Name*

Phone Number*

Electronic Signature

By clicking submit, I hereby authorize my veterinarian(s) to release ALL medical records for ALL of my animals I have had treated at the veterinarian(s) facility.

By clicking submit, I hereby certify all information provided is true and accurate. I understand false information will result in the automatic denial of my application. I also understand the Marion Grant County Humane Society has the right to deny this application at their discretion.

Thank you for your application. A representative of the Marion-Grant County Humane Society will contact you within 48 hours.

Adoption Application

Petfinder