Adoption Application - Humane Society of Elkhart County

WELCOME, AND THANK YOU FOR CONSIDERING ADOPTION OF A SHELTER COMPANION!

This application is designed to help determine what will be in the best interest of the animal and to assist potential adopters in finding a companion that is most compatible with their lifestyle.

Please understand that the animal's welfare must and will always be our foremost consideration. Therefore, the Humane Society reserves the right to approve or deny an adoption.

TERMS AND CONDITIONS FOR ADOPTION (PLEASE READ CAREFULLY & INITIAL EACH) AS A POTENTIAL ADOPTER, I UNDERSTAND THAT:

The animal(s) I adopt cannot be given away, and if I am unable to keep the animal(s), it/they are to be returned to the Humane Society of Elkhart County.

All persons living in household must meet the animal prior to adoption.

I must be able to provide necessary time and financial resources for appropriate training, medical treatment and proper care for the lifespan of the animal. The Humane Society will NOT reimburse me for any future veterinary expenses, including the required wellness exam. The Humane Society will not replace or provide a refund if my new pet does not get along with my current pet(s). A wellness exam may be required prior to adoption. If I am adopting a dog and I currently own a dog or dogs, a meet and greet appointment must be scheduled before I adopt the new dog. I must adhere to all laws and ordinances and in some cities, may be required to purchase a license for my companion animal.

ADOPTION APPLICATION We are delighted that you are interested in adopting a companion animal from us! Due to State laws regarding ownership, potential adopters must be 18 years of age or older. It will take approximately 1-2 business days to process your application. In order to help us be effective in processing your application, please fill out your application completely and truthfully.

TERMS AND CONDITIONS FOR ADOPTION (PLEASE READ CAREFULLY & INITIAL EACH)

(PLEASE READ CAREFULLY & CHECK EACH) By checking below you are agreeing to these terms.

AS A POTENTIAL ADOPTER, I UNDERSTAND THAT:*

The animal(s) I adopt cannot be given away, and if I am unable to keep the animal(s), it/they are to be returned to the Humane Society of Elkhart County.
All persons living in household must meet the animal prior to adoption.
I must be able to provide necessary time and financial resources for appropriate training, medical treatment and proper care for the lifespan of the animal.
The Humane Society will NOT reimburse me for any future veterinary expenses, including the required wellness exam.
The Humane Society will not replace or provide a refund if my new pet does not get along with my current pet(s).
A wellness exam may be required prior to adoption.
If I am adopting a dog and I currently own a dog or dogs, a meet and greet appointment must be scheduled before I adopt the new dog.
I must adhere to all laws and ordinances and in some cities, may be required to purchase a license for my companion animal.

APPLICANT'S INFORMATION

Full Name*

Email*

County*

List up to 3 animals of interest (hold).

* Email required in order to receive Pet Insurance Policy included with your adoption. By providing your email you consent to Pethealth, Inc. collecting and using your personal information for the purpose of contacting you with commercial electronic messaging and telephone communications.)

Address*

Street Address City State ZIP Code

Have you lived at this address at least 5 years*

Yes
No

Please provide your previous address.

Address

Street Address City State / Province / Region ZIP / Postal Code

Home Phone

Work Phone

Cell Phone

Select what type of home you live in:*

House
Apartment/Condo
Mobile Home

Please list ALL individuals, including yourself currently living in your household:*

FULL NAME (FIRST M.I. LAST)	RELATION TO APPLICANT	Age	Date Of Birth (IF 18+ YEARS)	DRIVER'S LICENSE/STATE ID # (IF 18+ YEARS)

Why do you want your new pet? (Check all that apply)

Guard Dog (Explain):

Where will your new pet be kept when you are not home?

Other (Explain):

Please list all cats, dogs and ferets currently living in your household

Name	Type (Cat, Dog, Feret)	Breed	Sex	Indoor or Outdoor	Age	Spayed / Neutered (Yes-No)

Are your current pets up to date on their Rabies vaccination?

Yes
No

If No, please understand that according to state law it is required that your current pets will need to be vaccinated for Rabies before you can adopt.

Current Veterinary Clinic:

Phone

Previous Clinic:

Phone

Are vet records under main applicant's name?

Yes
No

If No, whose name are the records under?

If approved for adoption, I would like to be enrolled in the Petco/PetPal rewards program.

Yes
No

How did you hear about us?

Other (Explain):

Consent*

INFORMATION RELEASE

I (OWNER'S NAME LISTED ON VET RECORDS) hereby authorize the release of my listed pet’s records from the VETERINARY CLINICS to The Humane Society of Elkhart County.

By submitting (Digital Signature):*

I CERTIFY THAT I UNDERSTAND AND AGREE TO THE HUMANE SOCIETY OF ELKHART COUNTY'S TERMS AND CONDITIONS FOR ADOPTION.

I CERTIFY THAT I UNDERSTAND AND AGREE TO THE HUMANE SOCIETY OF ELKHART COUNTY'S TERMS AND CONDITIONS FOR ADOPTION.
I FURTHER CERTIFY THAT THE INFORMATION GIVEN IN THIS APPLICATION IS COMPLETE AND TRUE.
I UNDERSTAND THAT ANY WITHHELD, INCOMPLETE OR FALSE INFORMATION MAY RESULT IN NULLIFYING THIS APPLICATION.
I GRANT THE HUMANE SOCIETY OF ELKHART COUNTY PERMISSION TO CONTACT MY VETERINARIAN AND OBTAIN RECORDS ON MY PRESENT/PAST ANIMAL(S).

Date

CAPTCHA

“Shall we all open our heart to be a forever home for lost pets.” — Martha Steward

Adoption

WELCOME, AND THANK YOU FOR CONSIDERING ADOPTION OF A SHELTER COMPANION!

TERMS AND CONDITIONS FOR ADOPTION (PLEASE READ CAREFULLY & INITIAL EACH) AS A POTENTIAL ADOPTER, I UNDERSTAND THAT:

TERMS AND CONDITIONS FOR ADOPTION (PLEASE READ CAREFULLY & INITIAL EACH)

APPLICANT'S INFORMATION

Contact Us

Hours

Newsletter Sign up!

Our Wish Lists