Adoption Application – Humane Society of Marion County Arkansas

Name of Applicant*

Occupation*

Name of Significant Other*

Occupation*

Name & Ages of Children*

Street Address*

City*

State*

Home Phone

Cell Phone*

Work Phone

E-mail*

Do you live in a*

House
Apartment
Condominium
Town House
Other

Do you*

Own
Rent

If you rent, do you have your landlords permission to have a pet?*

Landlord's Name and Phone Number*

How much of the time will the animal be outdoors?*

How much of the time will the animal be indoors?*

About what percent of the time will the animal be left alone?*

Where will it be when left alone?*

What area(s) of the house will the animal be allowed into?*

Where will the animal sleep at night?*

Do you have a fenced yard?*

If so, how high is the fence and what type?

Are the gate(s) normally locked?

Do you have a pool?*

If so, is it fenced separately from the yard?

Why do you want a pet? (Check all that apply)*

House pet
Companion for family
Companion for other pet
Companion for children
Protection for home/family
Protection for business
Watchdog
As a gift

Specify if Other Reason:

Other Pets (specify kind and number of each*

If you have any dogs or cats, are they spayed/neutered?*

What pets have you had in the past?*

What happened to the ones you no longer have?*

What would happen to the animal if you moved locally?*

What would happen to the animal if you moved out of state?*

What would happen to the animal of you moved out of the country?*

Do you have a regular veterinarian?*

If so, vet's name and phone number*

May we contact him/her? (if so please let them know we will be calling)*

Will you be able to live with hair on your furniture, stains on your rugs, a warm body on your bed, and an animal that might be destructive at time?*

Remember, pets are an investment of your time and money. Can you afford to provide medical care, grooming, proper diet, proper shelter and exercise for your new pet?*

Are you able to make a long term commitment to care for your pet for its entire life span, which could be as much as 10-20 years?*

Under what circumstances would you not be able to keep this animal?*

Which of our animals are you interested in adopting?*