Adoption application

ADOPTION APPLICATION

Today's Date *

I am 18 years of age or older *

I agree

Sex of animal you wish to adopt *

Male

Female

Animal interested in *

Dog

Cat

Email: *

Animal Shelter

Martin County

Humane Society

I understand that if I have pets in the home, I will introduce any new pet slowly and with supervision *

I agree

Is anyone in your home allergic to pets? *

Yes

I understand that the dog/cat I am adopting cannot be permitted to run loose, becoming a nuisance to neighbors or other residents. I will not leave my dog unsupervised to roam free. *

I agree

I understand that if I can no longer keep the dog/cat I am adopting, I will contact the Martin County Humane Society immediately and return the animal. I will not give the dog/cat away or surrender it to another animal rescue/shelter *

I agree

Landlord's name & phone number

If yes, please list ages of children in the home

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. *

If you answered "yes" to the question above, please explain why.

If a renter, may we contact your landlord to confirm permission for this dog/cat to live in the home?

Yes

What animals do you currently own? For other dogs and cats, please list breeds and ages. *

Phone *

Name: *

Street Address *

I realize that adopting a dog/cat can be a 10+ year commitment *

I agree

At times, we receive MULTIPLE applications for a dog/cat. Please be patient while we review them and get back to you. We are a volunteer-only organization.

Have you ever surrendered a pet to ANY animal shelter or given away a pet? *

Yes

If you answered "yes" or "tried but was unable" to the question above, please explain what animal(s) you adopted or why you were unable to adopt.

Have you ever adopted from an animal shelter before? *

Yes

Tried but was unable

Do you Own or Rent your home? *

Own

Rent

Other

City, State & Zip *

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

I agree

I understand that owning a dog/cat can be expensive *

I agree

Where will this dog/cat be kept? *

Inside

Outside

Garage

Other

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

I agree

Do you live in a house, apartment or other *

House

Apartment

Other

Do you have children in the home? *

Yes

Comments, Questions? Or when you are available to meet this dog/cat.

Name of animal you wish to adopt *

507 N Oak Street

Loogootee IN 47553

812-295-5900

mchs@frontier.com

I understand, if adopting a dog, I will not keep the dog chained/tied outside for long periods of time *

I agree

If other, please explain

I will give my new dog/cat adequate time to adjust to its new environment *

I agree

I understand that if the animal I adopted 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 *

I agree

Please read and acknowledge the following: