Dog Adoption Application

Humane Society of Marion County
701 NW 14th Rd Ocala FL 34475
352-873-7387
Frontdesk@thehsmc.org

Today's Date *
List animals you would like to meet with *
Identification
First Name *
Last Name *
Address *
City *
State *
Zip Code *
What county do you live in? *
What is your date of birth? You must be at least 21 years of age or older to adopt. *
Phone Number *
Email *
Employment
Employer *
Housing
Do you Rent or Own? *	Rent Own Other
Length of Time at Residence *
If renting, what is your Landlord's Name?
If renting, what is your Landlord's Phone Number?
If renting, do you have a pet deposit?
If renting, do you have a breed restriction?
If you relocate or move, what will you do with this dog? *

Please list all adults & children, full names and ages below. (Ex. John Smith 21, Jane Doe 24) *
Is anyone allergic to cats? *
Is anyone allergic to dogs? *
Current Pet Information
Leave blank if you do not have any current pets
Are all of your current pets up to date on vaccines?
Are all of your current pets on Flea and Tick Preventative?
Are all of your current pets on Heartworm Preventative?
List the animals by name that are currently in your home. Please include species, age, and time in family. (Ex. Daisy, Cat, 5 Years Old, with us for 6 months)
Pet History
List the animals by name that are no longer with your family. Please include the past 5 years. Please include species, age, time in family. (Ex. Spot, Dog. 15 Years Old, with us for 5 Years). If this does not apply to you, please leave blank. *
Vet Information
Veterinarian's Name or Practice
Additional Information
I want a pet as a: *	Family Companion Guard Dog Gift Yard/Farm Dog For my Children Protection Stress/Anxiety Companion for another animal
I am looking for a pet that is: *	Good with Children Good with the Elderly Good with Cats Good with Dogs Good with Livestock Calm Active Friendly Playful Aggressive Laid Back Other
Have you ever surrendered an animal? *
If yes, why and where?
When I am home, my pet will be: *	Loose in the house In the yard Runner Crate Inside Crate Outside Garage Confined in one room Barn Other
When no one is home, my pet will be: *	Loose in the house In the yard Runner Crate Inside Crate Outside Garage Confined in one room Barn Other
I am prepared to spend this amount of time training my pet: *
How much time will you commit to fully allowing your pet to adjust? *
Are you aware that this pet could cost more than $100 dollars to get established? *
Are you willing to care for this dog for the rest of its life? *
What would cause you to give up your pet? *
Humane Society of Marion County Adoption Application Agreement
*	I am aware that a $25 payment per animal is required to reserve the pet named above. The $25 constitutes a “hold” which may not last longer than 3 days and may be terminated by the HSMC for failure to comply/provide the requirements above. I affirm that no member of my household has been convicted of any animal welfare law violation such as neglect, cruelty, abandonment, etc. I understand that this adoption is conditional on providing vet records for all current/past pet(s) if need be. I understand that this adoption is conditional on a meet and greet of all required animals and required people in the home. I also agree to care for the adopted animal(s) in a humane and responsible manner and to provide it with appropriate shelter, food, water, exercise, companionship, and veterinary care. I understand that HSMC takes every precaution to assure the health of its adoptable animals; however, the HSMC can make NO GUARANTEE of any kind regarding the health, temperament, breed, or behavior.
By signing below, I authorize the Humane Society of Marion County to contact: • My Veterinarian(s) (to check the care provided & spay/neuter history on current/past pets) • My Landlord (to ensure that I have permission to keep a pet(s) on the premises, if I have a pet deposit if I have pet rent, and if there is an agreement that needs to be signed) • My employer (to confirm my employment)
I (Name)________________agree that I am adopting solely as a pet(s) for myself and/or my immediate family living in my home. I agree that I will not sell, give away or otherwise dispose of said pet(s) to any person(s) or other entity for any reason without prior approval of H.S.M.C. If, at any time I am unable or unwilling to keep this pet(s), I agree to contact the H.S.M.C. and give H.S.M.C. the opportunity to take back the pet(s). In addition, I understand the adoption decision is dependent on many factors, including but not limited to the compatibility of the family and home to the individual animal. I understand the H.S.M.C. has the right to deny any adoption at any time for any reason. I certify that all the statements made by me on this adoption agreement are true and correct. I agree that H.S.M.C. has the right to confiscate the adopted animal if any statements made by me are found to be false and/or my payment for the adoption is returned for insufficient funds. *

Dog Adoption Application

Identification

Employment

Housing

Current Pet Information

Leave blank if you do not have any current pets

Pet History

Vet Information

Additional Information

Humane Society of Marion County Adoption Application Agreement

By signing below, I authorize the Humane Society of Marion County to contact:

• My Veterinarian(s) (to check the care provided & spay/neuter history on current/past pets)

• My Landlord (to ensure that I have permission to keep a pet(s) on the premises, if I have a pet deposit if I have pet rent, and if there is an agreement that needs to be signed)

• My employer (to confirm my employment)