Adoption application

507 N Oak Street

Loogootee IN 47553

812-295-5900

info@humanesocietyofmartincounty.org

Animal Shelter

Martin County

Humane Society

Who is your vet? If you don't have a current vet, name a vet you have used in the past.

Applicant's Name: *

Name of animal you wish to adopt (if known)

Email: *

Do you currently own any pets? If so, list each and include ages and breed (for dogs) and how long you have owned each. *

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

I agree

I do not agree

I understand that owning a dog/cat is expensive *

I agree

I do not agree

Have you ever surrendered or given away a pet, for any reason? If yes, explain when and why. *

I understand that the dog/cat I am adopting cannot be permitted to run loose and unsupervised. I will keep the dog/cat on my property at all times or under my control if not at home. *

I agree

I do not 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 to the shelter. I will not list the animal on social media, I will not give the animal away or surrender to another shelter. *

I agree

I do not agree

Have you ever adopted or tried to adopt from an animal shelter? If yes, explain what was adopted or why you didn't end up adopting. *

If you rent, include landlord's name and phone number.

Please list everyone living in your home, their relationship to you and their ages *

I am interested in adopting *

Dog

Cat

Phone *

If you don't have children living in the home, do you have children that frequently visit your home? If so, list their ages and explain how often they visit your home.

Please note that some animals receive multiple applications so it may take a few days to get back to you. We review applications in the order they come in. We are a volunteer-only organization so we do our best to get back to you as quickly as we can but we also work "paid" jobs along with our volunteer work at the animal shelter.

Where will your new pet be kept? *

In the house

Outside

In the garage

Other

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 *

I agree

I do not agree

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 applicant agrees to this, sign below. You will be required to sign again in person if application is approved. *

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

I agree

I do not agree

When is the best time to reach you? When would you like to meet the dog/cat you are interested in?

City, State & Zip Code *

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. *

I agree

I do not agree

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

I agree

I do not agree

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

I agree

I do not agree

Date

Is anyone in your home allergic to dogs or cats? *

Yes

Not sure

I am 21 years of age or older *

I agree

I do not agree

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

I agree

I do not agree

Street Address *

ADOPTION APPLICATION