HSAC Dog Adoption Application

Please use this form to apply to adopt one of our wonderful dogs or puppies.

We want to reduce pet homelessness. Your honest and thoughtful responses will help us match your family with the best dog/puppy for your lifestyle.

How did you hear about us?
Which dog/puppy would you like to adopt?
If the name of the animal you wish to adopt is not on the above list, or if you would like help choosing the right pet for your family, please let us know what breed, size, age and temperament pet you are interested in adopting.
Your First Name (required) *
Your Last Name (required) *
Home Phone *
Cell Phone
Street Address (required) *
City (required) *
State (required) *
Zip Code
E-Mail Address
Please list all members of your household, including yourself, and their ages. *
Do you have young children visit on a regular basis? (i.e.grandchildren, babysitting, friends with small children)? *
If you checked "yes" to the above question, please tell us more about the young children that visit. Please include ages of all children and frequency of visits.
Please list your employer and your spouse/partner's employer. Pet care can be expensive and many pets are surrendered to shelters due to inability of their families to afford their care. We want to ensure that your household has the means to afford this pet's care.
Do you own your home? *
If you rent, please provide your landlord's phone number. We will contact your landlord to ensure that the pet you wish to adopt will be permitted on the property.
Please list the other pets that live in your household, including species, breeds, and ages. We love to hear about your animal family members! *
Are these pets spayed/neutered? If you have current pets that are not sterilized, please explain why. *
Do you have a regular veterinarian? *
If you answered "yes" to the above question, please tell us the name and phone number of your regular veterinarian. We will contact your veterinarian to verify that your current pets are spayed/neutered and are up-to-date on their vaccinations. If you do not have a current veterinarian, please describe which veterinarian you plan to use for yearly health checks and if your pet gets sick. *
For whom are you adopting this dog/puppy? If for someone else, please explain. Do they know? *
Please describe why you are excited about adopting this dog/puppy. *
If you can no longer care for this pet, we require the pet to be returned to HSAC. Do you agree to this condition? *

Humane Society of Adams County,Inc.