Adoption Form

Description	Variants
Name	Gypsy
Gender	female
Age	Not available
Size	Medium

Pet name

Pet age

Pet Gender

Pet Size

Date fill

First Name *

Last name *

Email *

Phone number *

Address *

State *

City *

Zip Code *

What animals do you currently own? (Include breeds (for dogs) and ages of all animals) *

Have you EVER surrendered / Given away a dog or cat for any reason? *

if yes, please explain Why *

Have you ever adopted or tried to adopt from any humane society / animal shelter? *

If yes, Explain outcome *

Which describes your living situation (Choose one) *

Own

Rent

Live with parents

Live with someone temporarily

If you rent, may we contact the landlord to obtain permission for this dog / cat to live in your home? *

Landlord name & phone number *

Do you live in a (select an option) *

House

Apartment

Duplex

Mobile Home Complex

Other

If other explain *

Do you have children living in the home? *

If yes, Age of children *

Do you have children/Grandchildren the frequent your home? *

If yes, Ages of children *

Where will this Dog/Cat be kept? *

In the house

Outside

Garage

Is anyone in your household allergic to animals? *

Who is your vet *

Please List everyone living in your home and their relationship to you *

Please Read and Agree to each item.:

I am 21 years of age or older (21 is the minimum age allowed to adopt) *

Yes

I understand that if i have other pets, I will introduce my new pet slowly and with supervision *

Yes

I will give my new dog/cat adequate time to adjust to its new environment before wanting to give him/her back. Shelter pets require several days to adjust to a new environment. They will not immediately acclimate to their new home. They are, oftentimes, scared and confused and need your help to feel comfortable and safe. This takes longer than a few days/nights *

Yes

Everyone in my home is aware and approves of my decision to adopt a dog/cat *

Yes

I realize that adopting a dog or cat can be a 10-year or more commitment *

Yes

I understand that owning a dog/cat is expensive and they need annual vaccinations and vet visits along with flea and heartworm preventative every month *

Yes

I understand that if the animal I adopt becomes ill, within 7 days after adoption, I will contact the Martin County Humane Society immediately or the vet used by the Martin County Humane Society *

Yes

I understand that the Martin County Humane Society will not be responsible for vet bills incurred by another vet not used by the Martin County Humane Society *

Yes

I understand that, if adopting a dog, I will not keep the dog chained/tied outside *

Yes

I understand that the dog/cat I am adopting cannot be permitted to run loose and unsupervised *

Yes

I certify the above information is true. I understand that giving false information on the application is grounds for denial of application and repossessing the dog/cat if the application is approved. I understand the Martin County Humane Society reserves the right to deny any application. By signing below, adopter is fully aware that the Martin County Humane Society makes no guarantees whatsoever as to the health, temperament, mental disposition and training of the dog/cat. adopter hereby fully and completely releases the Martin County Humane Society, its agents or volunteers, from any defects or illnesses that the dog/cat may have or develop and from any claim, cause of action or liability for any injury or damage to persons or property, which may be caused by the dog/cat and to indemnify and hold Martin County Humane Society harmless against all claims, including, but not limited to those asserted by third persons, for any injury or damage to persons or property caused by the dog/cat. *

Yes

Adoption Interest Form

Please Read and Agree to each item.:

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