A No-Kill, 501 (c) 3 Non-Profit Animal Rescue Organization
 Shelter Address: “HappyPaws Farm”, 19933 Old Burn Rd., Arlington, WA.
Mailing Address: 8304 Wayne Ave, Stanwood, WA 98292
Tel: (360) 652-5844; Email: hmnsoc@aol.com; Web: http://www.saveourdogs.com

PET ADOPTION APPLICATION FORM


Current Date:

 

 

 

 
Name:

 

 


Mailing Address:

 


City:

 


State:

 


Zip:

 


Phone:

 


Cell Phone:

 


Email Address: 		 



Describe the animal you are seeking to adopt:

 


Animal’s name if you saw it on the Web:

 


If a specific animal, how did you learn about it?


q       Petshelter.com
q       Saveourdogs.com
q       Newspaper
q       Television
q       Friend
q       Advertisement posted in: ________________
q       Other: _______________________________

 


Would you consider a senior pet, over age 7



q       Yes
q       No

 



Would you consider a pet from another part of the country if this entailed airfare of $150.00 (est.) to bring it here?




q       Yes
q       No

 

 



Would you consider a small animal (under 25 lbs.) from another part of the world (normally cruelty, starvation, or severe hardship cases, $150 airfare)? Note: all medical work would be undertaken prior to its arrival.




q       Yes
q       No

 



Are you over 21 and one member of the family employed full-time?




q       Yes
q       No

 

 

If yes, where are you employed?

 



If you work full-time, what will happen to your pet when you are at work?




q       Stay in yard
 q       Stay in house
q       Doggie door from house to yard
q       Crated in house # of hours: ___
 q       Other: ___________________

 

 

Does your workplace have a donation-matching program or do you or a family member work for Microsoft?

 

q       Yes
q       No
q       Microsoft

 

  



Is this to be your first pet?



q       Yes
q       No

 


If no, what kinds of pets have you had in the past?

 


Which of these do you still have? Include age, sex, and breed.

 

 

 

 

 


Have they been spayed or neutered?



q       Yes
q       No

 

 

About how many times per year do they visit the vets?

 

 

For what purpose?

 

 

What happened to the pets you no longer have?

 

 

If you currently have pets, will it/they adjust to a new animal in the house?




q       Yes
q       No

 


Why do you want this animal?



q       Companion for self
q       Companion for other pet
q       Personal protection
q       Watch dog
q       Guard dog
q       Hunting
q       Present for someone else
q       Other

 


How many adults are there in your family?

 


Does everyone want this pet?



q       Yes
q       No

 

 

How many children?

 

 

Children’s ages and gender:

 

 

Have you, or any family member, ever been convicted of a felony?




q       Yes
q       No

 


Do you agree to a State Patrol check done on your Social Security number, if deemed necessary?



q       Yes
q       No

 


Does any member of your household have an allergy to animals?



q       Yes
q       No

 


Has any member of your household been bitten by a dog?



q       Yes
q       No

 


Has an animal you have had ever been hit by a car?



q       Yes
q       No

 


How many hours each day will the animals be left alone without an adult present?

 


Which do you live in?

 


q       House
q       Apartment
q       Condo
q       Mobile
q       Home
q       Other: ____________  

 

 


Do you own or rent your home?



q       Own
 q       Rent

 

 

 


If you rent, may we contact the owner/manager to obtain permission for this animal to live in your home?



q       Yes
q       No

 

 

Owner/manager’s name:

 

 

Telephone No.:

 



Do you have a COMPLETELY fenced yard?  This means there is no way for a dog to easily leave the yard.




q       Yes
q       No

 


If yes, what type of fencing is it:



q       6 Ft. Chain link
q       4 Ft. Chain link
q       6 Ft. Wood
q       Picket fencing
q       Other: ______________

 

 

 


If no, how do you plan to contain the animal?

 


May we contact your veterinarian?



q       Yes
q       No

 

 

If yes, please indicate name:

 

 

Telephone no.:

 

 

If you go away for a few days, who will take care of the animal?

 

 

If you go away for an extended vacation, who will take care of the animal?

 

 


Are you willing to exercise a dog on a daily basis?

 



q       Yes
q       No

 


Are you willing to clean up waste on a regular basis?

 



q       Yes
q       No

 


Are you willing to feed/water on a daily basis?

 


 

 

Where will the dog be kept during the day?

 

 

Where will the dog be kept during the night?

 

 

Will you make sure the pet has heat during the day and night during the Winter months?

 




q       Yes
q       No

 

 

 

What type of heat/protection?

 

 

If you drive a pickup truck, how would the dog travel in that truck?

 

 

If you move, what will happen to your pets?

 

 

What training do you plan to obtain for the dog that your are adopting?



q       Professional Training
q       Train Ourselves
q       Our Kids Will Train
q       We Don’t Have Time For Training
q       Training Classes At Places Such as
       PetsMart, Canine Academy, 4H, Etc.
q       The Dog Doesn’t Require Training

 


Have you ever asked an animal welfare group or a county shelter to take one of your animals?



q       Yes
q       No

 


Have you ever had an animal euthanized?


q       Yes
q       No

 

 

 

If yes, why?

 


Are you willing to have a representative of the Humane Society come to see where the pet will be living?



q       Yes
q       No

 

 


Are you willing to take the responsibility and feed/care for an animal for the next ten to fifteen years?



q       Yes
q       No

 

 

Name, address, and telephone of two references, not including your veterinarian:

 

1.

 

 

 

 

 

2.

 

 

 

 

 

I certify that the above stated information is true, correct, and complete.  I verify that I am 21 years of age or older.   I also authorize that my references and my veterinarian can be contacted, and a visit made to my home before the adoption is completed.  If I am not home, I authorize a representative of the Humane Society to inspect and enter my back yard.

 

 

Date:

 

 

Date:

 

 

Printed Name:

 

 

Printed Name:

 

 

Signature:

 

 

Signature:

 

 

A No-Kill, 501 (c) 3 Non-Profit Animal Rescue Organization
 Shelter Address: “HappyPaws Farm”, 19933 Old Burn Rd., Arlington, WA.
Mailing Address: 8304 Wayne Ave, Stanwood, WA 98292
Tel: (360) 652-5844; Email: director@saveourdogs.com; Web: www.saveourdogs.com

 PET ADOPTION

I/We agree that if ever I/we find that I/we can no longer keep an animal adopted to us by the Humane Society - Western Region or HS-WR, I/we will return it to the Humane Society - Western Region or HS-WR at 19933 Old Burn Road, Arlington, or someone will come from HSSC and pick the animal up.  Please give us a week's notice prior to bringing the dog back unless it is an emergency situation.

In such cases as above, any fees paid for the dog will not be reimbursed. If I/We have this animal euthanized, taken to a shelter that euthuanizes, used for research, or in any other way dispose of it, other than by a veterinary certified serious illness or accident, then $3,000 is due and payable to the Humane Society - Western Region or HS-WR to be applied toward the saving of other animals.

I/We agree not to abuse the animal, tie it up, or confine the animal for extended periods, fail to provide food, water, shelter, and light, or any like situation(s). I/We also agree that I/We will not dock any dog's tail or crop it's ear.  If any of these instances occur, or your check fails to clear the bank, I/we understand the Humane Society of Snohomish County will enter my property and remove the animal from my premises and it will not be returned, nor will a refund be provided.  I agree to their entering my property for such a purpose.