Adoption application

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

Please read and acknowledge the following:

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.

Do you have children in the home? *

Yes

Landlord's name & phone number

If yes, please list ages of children in the home

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

ADOPTION APPLICATION

Today's Date *

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.

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

Live with parents

Other

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. *

I am 21 years of age or older *

I agree

I do not agree

Sex of animal you wish to adopt *

Male

Female

Name of animal you wish to adopt *

Phone *

Animal interested in *

Dog

Cat

City, State & Zip *

Name (first & last) *

Email: *

Street Address *

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

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

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

Animal Shelter

Martin County

Humane Society

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

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

If other, please explain

Where will this dog/cat be kept? *

Inside

Outside

Garage

Other

Is anyone in your home allergic to pets? *

Yes

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