Humane Society of Kodiak Adoption Application

Please fill out the application in it's entirety Applications with blank and unanswered questions will be considered incomplete.

Is there a specific shelter pet you are interested in adopting? If yes, who?
Are you interested in a dog or cat *	Dog Cat Both
Have you adopted from the Humane Society of Kodiak before? *	NoYes
If yes, who did you adopt and when?
I understand that there is a minimum of 24 hours waiting period on all adoptions. *	NoYes
I understand the Humane Society of Kodiak reserves the right to refuse adoption to anyone *	NoYes
I understand that the Humane Society of Kodiak will not adopt to persons who mislead or fail to provide complete, truthful and accurate information *	NoYes
Yes, I am 21 years of age or older *	NoYes
Personal & Family Information
Applicant's first name *
Applicant's last name *
Mailing Address *
Physical Street Address *
City *
State *
Zip Code *
Phone Number * Please use the following format 248-555-1212
Email Address * Please enter correctly
Applicant's employer *
If in the military, when is your transfer date?
Co-applicant first name
Co-applicant last name
Co-applicant employer
Names of all adults in household *
Number of children in household and ages *
Does anyone in your household have allergies to dogs or cats? *	Yes No Possibly N/A
Is everyone in your household aware that you are planning to adopt a pet? *	Yes No N/A
Home Information
Please select your current residence type. *	House Apartment Condo Townhouse Mobile Home Other
Do you own or rent your home? *	Own Rent Military Housing
Landlord's first & last name and phone number. IF YOU RENT YOUR HOME THIS IS REQUIRED
(FOR DOG ADOPTION ONLY) Do you have a fenced-in yard? If so, what kind of fence? *Only answer if you are wanting to adopt a dog. If not, skip to 30	Wood Chain Link Electric Plastic Iron Other Other (I do not have a fenced yard) No fenced yard
If you answered "other" above, please explain:
Current & Past Pets
Do you currently have any pets in the household, even if they are not yours? *	NoYes
Are all pets in the household current on their vaccinations? *	Yes No Unknown NA
If yes, please list names, breed and ages of all pets in the household
Are all pets in the household spayed or neutered? *	Yes No Unknown NA
If any of the pets are not current on vaccines or spayed/neutered, please list who and explain why?
Pets you have owned in the last 5 years? (name, age, breed) If none, please enter "none" *
If they no longer live with you, what happened to them?
Adoption Information
Please check the main reason you plan to adopt a pet: *	Companion Family Pet Child's Pet Guard Dog Companion for another pet Other
If you are wanting to be put on our wait list, please describe in detail the type of pet you are looking for. If you are looking for a specific type of pet, please describe in as much detail as possible.
On average, how many hours per day will your pet be left alone? *	2-4 hrs 4-8 hrs 8-12 hrs 12+ hrs None
Where will your pet be kept when you are not home? *	Free inside house In a crate Outside in a fenced yard Outside on a tie out
When inside, how do you plan to keep you pet? * Select all that apply	Free inside house Confined to crate Inside a closed room Other
Where will the animal sleep? *	In bed with me In bed with my child In a dog / cat bed In a kennel / crate Wherever he or she likes Outside
(FOR DOG ADOPTION ONLY) :If you do not have a fenced yard, how will you let the animal out?	Tie Out Dog Run Leash & Regular walks
(FOR DOG ADOPTION ONLY):Are there times when the animal will be tied/chained up?	Yes No N/A
For what reason(s) would you consider returning/giving up the animal? Please select all that apply *	Moving Job Kids Too Busy Divorce/Separation New Baby Vet Care Pet Too Big/Too Small Bad Habits Bit Someone (provoked) Bit Someone (unprovoked) None
Veterinarian or Clinic's Name If you have never owned a pet please tell us where you would go.
Veterinarian's Phone Number
Please provide the name, relationship to you and contact number of personal reference, must NOT be relatives or live in your household. Please provide the name, relationship to you and contact number of personal reference, must NOT be relatives or live in your household.
Please provide the name, relationship to you and phone number of personal references, they must NOT be relatives or live in your household. * Please provide the name, relationship to you and contact number of personal reference, must NOT be relatives or live in your household.
Is there any other information that you would like to provide along with your application?
I have read the foregoing and certify that the answers I have given are complete, true and not misleading in any way. I am authorizing you to contact landlords, associations, personal references and veterinarians. I understand that this application does not guarantee adoption approval. You are also aware that we cannot guarantee the health and temperament of the animal. *	Clear
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