Name of Animal interested in Adopting?
First and Last Name:
Address Line 2
Are you 21 or over?
Will an adult be home during the day?
Do you have a fenced yard?
If you have a fenced yard, is it a chain link? privacy? How tall is the fence?
Type of dwelling (Apartment, single family residence, duplex, townhome, condo, loft, etc?)
OwnRentLive at home
If you rent: Are pets allowed?
Does your landlord require a security deposit?
(proof of payment required before the adoption can be completed)
If less than one year at current residence, please provide previous address:
Length of time at previous residence?
1 to 3 years3 to 5 years5 or more years
Do both adults work outside the home?
Number of adults in the home:
Number of children in the home and ages:
Do you currently have other dogs or cats?YesNo
If yes, please give names, breeds and ages, as well as any other relevant information about the pet: (Type N/A if not applicable.)
Is your dog on heartworm prevention? Which brand and where do you purchase it?
If you have current pets, are they spayed/neutered?YesNo
If no, please explain as it is a requirement for approved adoption applications: (Type N/A if not applicable.)
If you don’t currently own a pet, have you owned one in the past?YesNo
If yes, please explain why the pet is no longer with you: (Type N/A if not applicable.)
Name/address/phone # for current veterinarian (To check current pet records.)
Where will your pet stay during the day?
Where will your pet stay at night?
If you are adopting a cat/kitten are you planning to have it declawed?
If you are adopting a cat/kitten are you planning to let it go outside?YesNo
Why do you wish to adopt this type of animal?
CompanionAs a gift for someoneOther
If you selected other above, please specify:
This questionnaire must be completed by anyone interested in adopting a pet from the Henry County Humane Society (HCHS). We at HCHS try to place our animals into permanent, responsible homes, while matching the pet to you and your lifestyle.NOTE: THE PROVIDING OF FALSE INFORMATION HEREIN WILL RESULT IN THE FORFEITURE OF ADOPTION FEES AND ANY ANIMALS ADOPTED. We reserve the right to refuse an adoption based on poor or incomplete vet history. I authorize HCHS to contact the veterinarian office named above to confirm the medical records/history of my pets.
We get multiple applications for each dog and cat. We review each application submitted and choose the best fit for the animals in our care. We do not go by a first come, first served basis. We rely heavily on your previous pet owning experience and your veterinarian's report of your current or previous pet's medical history. Only applications that are completed in full will be considered. Please understand that due to the number of submissions received, we cannot respond to every application. If you are chosen for a particular dog or cat, we will contact you via email to schedule a time/day for a meet and greet. Submitting the application does not obligate you to adopt should you meet him/her and decide they are not a good fit for your home and family. If you do not hear back from us, your application was not chosen.