Pet Adoption Application

Thank you for your interest in pet adoption! Please fill out and submit the form below.

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Personal Information

Which pet are you
interested in adopting?
Your First Name:
Your Last Name:
Address Street 1:
Address Street 2:
Zip Code: (5 digits)
Home Phone:
Work Phone:
Cell Phone:
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Household Information

How did you hear about us?
How long have you lived
at your present address?
Own or Rent?
Please list all adults living
in the home and their ages
(including yourself):
Please list all children living
in the home and their ages:
Fence - How high and what
is it made of (chain link, stockade,
invisible, etc):
Do you already have dogs?:
Please enter the following
for each dog:
Do you already have cats?:
Please enter the following
for each cat:
Do you have any other animals?:
Please describe your other animals:
Have you owned a dog or cat
as an adult before?
When did you own the previous pet?
What breed was the previous pet?
What happened to the previous pet?
Why do you want to adopt?
What is your work schedule?
How long will the pet be alone?
Where will the pet be when alone?
Where will the pet be during the day?
Where will the pet be at night?
Exercise Plan, please explain:
How will the pet be cared for when
you are out of town?:
Do you have experience with
crate training?
Are you willing have a
Humane Society of Houston
County volunteer visit your
home by appointment?
Ideal pet (Color/Gender/
Notes (please use this space
to tell us any additional information
and/or which dog / cat you might
be specifically interested in):
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Security Question

Please answer the following question.
What is 2 + 2?:
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Veterinary Information for Current Pets

Note: If you do not have a vet now, please list an additional reference here.
Vet's / Reference's Name?
Business Name / Relationship to you:
Vet's / References's Address:
Vet's / References's Phone:
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I agree to allow the Humane Society of Houston County, Inc. to contact my vet or any of the people listed as references on this application to discuss the information listed herein. I have answered the above questions truthfully and to the best of my ability. I also understand that the Humane Society of Houston County, Inc. may refuse or deny my application for adoption on any grounds. I understand that if I am e-mailing this application, my e-mail is my signature. Further, my signature below indicates that I am at least 21 years of age and intend to be the legal owner and the person responsible for the care and well being of any animal I adopt from the Humane Society of Houston County, Inc.