Potsdam Humane Society Adoption Application

A complete application can be processed quickly, so please answer ALL questions to the best of your ability, leaving no blanks. For questions that are not applicable, mark “N/A.”

Once we receive your application, it will be processed and a shelter representative will be in touch with you. Please allow 24 – 48 hours minimum for processing.

Shelter ID # or Name(s) of animal(s) you wish to adopt: *

Personal Information

Name *

Address *

City *

State *

Zip *

Township *

County *

Number of years at current address *

Email *

Primary Phone *

Secondary Phone

Co-Applicant Name

Co-Applicant Phone

Housing Situation

Rent

Landlord's Name

Landlord's Address

City

State

Zip

Phone Number

Own a home

Live with parents

Contact Information

Live in a dorm

Live in a fraternity/sorority

Have a roommate

Contact Information

Go to school

Residence is:

Rural

Suburban

City

Are you planning to move soon?

Yes

Do you have reliable means of transportation?

Yes

Employment Status

Applicant

Employed

Retired

Active Military

Retired Military

Unemployed

Place of Employment

Employer's Phone

Co-Applicant

Employed

Retired

Active Military

Retired Military

Unemployed

Place of Employment

Employer's Phone

Pet care is increasingly expensive, especially veterinary care. Will you be able to provide proper nutrition, veterinary care, and annual vaccinations for a pet? Please explain.

Current Situation Information

Are you 18 or older? *

Yes

Are you planning to move soon? *

Yes

If you have children, how old are they?

Will small children be supervised with the pet?

Yes

Does anyone in the home have allergies to animals? *

Yes

If yes, how will this situation be handled?

This pet is for: *

You

Family member

Other..

You want to adopt an animal as a: *

Pet

Family Pet

Hunting

Gift

Companion

Watchdog

Companion for another animal

Other..

Past and Present Pet Information

Have you ever brought an animal to a shelter? *

Yes

If yes, complete the following:

Dogs

How Many?

What Type?

Pet's Age

Spayed or Neutered?

Cats

How Many?

What Type?

Pet's Age

Spayed or Neutered?

Puppies

How Many?

What Type?

Pet's Age

Spayed or Neutered?

Kittens

How Many?

What Type?

Pet's Age

Spayed or Neutered?

Why was the animal(s) surrendered to a shelter?

Have any of your pets been adopted from a shelter?

Yes

How many pets have you owned in the last five years?

What happened to them?

Do you have one or more pets now?

Yes

If yes, complete the following:

Pet's Name

Dog or Cat

Dog

Cat

Spayed or Neutered?

Age

Breed

Dates of Vaccinations

Place where pet was vaccinated

Your Veterinarian's Name

Veterinarian Phone Number

Owner’s name listed on file at vet’s office:

In the past three months, have you had a pet die on your premises from distemper, leukemia, parvo or an unknown cause?

Yes

Animal Welfare Information

Where will the pet live? *

Inside

Outside

How will you keep your pet safe when he is outside? *

Where will the pet sleep? *

Who will be responsible for the pet’s care? *

How will you handle your adopted pet’s behavioral issues if any? *

Will you be willing to train your pet or go to training classes with him/her? *

Yes

Do you know your local ordinances pertaining to pet licensing? *

Yes

Under what circumstances would you rehome your pet? (check all that apply) *

Change in domestic status (marriage, divorce, new baby, new pet, etc.)

Moving

Training issues with pet

Pet grew too big

Pet is too loud

Pet has too much energy

Neighbors complain about pet

Pet does not get along with other animals

Pet shows aggression toward humans

Pet shows aggression toward other animals

All of the above

None of the above

We have a list of local Veterinarian that are willing to give your adopted pet a free physical exam if called with in three days of the adoption, would you be interested? *

Yes

Are you aware Animal Control has the right to visit your home and remove the pet if it is not receiving adequate care? *

Yes

Do you know that pets from PHS are to be brought back to PHS if needed to rehome?

Yes

Additional Information

Would you object to a shelter representative inspecting the pet and the premises where the pet is to be kept? *

Yes

Do you feed your pet Hill’s Science Diet food? *

Yes

If yes, how often do you purchase it?

If no, what brand do you feed your current pet or plan to feed this pet?

Do you give us permission to submit your name to Hill’s Science Diet to receive valuable coupons? *

Yes

No refunds are given on dogs over four months of age. A partial refund may apply on dogs under 4 months depending on circumstances. Cats and kittens have a full refund if returned with in 30 days of adoption date. On return of a pet all adoption papers must be returned with the animal. Please be sure this is the pet you want.

Signature *

Date *

Thank you for offering a home to an animal in our care.

Important: Do you understand the pets we have usually have no or little history to go with them? They have often been surrendered by their owners, picked up as strays, or have been abandoned. We try to evaluate their temperament, but that is not always a true measure of how a pet will behave when become a part of your family. Giving a pet a chance at a new and loving life can take work.

Are you willing to dedicate yourself to doing that work? *

Yes

Extra Dog Adoption Questions

Are you applying to adopt a dog? *

Yes

If yes, please answer the following extra dog adoption questions:

Are you open to adopting a pet who might not be house-trained?

Yes

Is there a yard for your dog?

Yes

Is there an enclosed fence?

Yes

Please describe the type of fence (height, material, etc.)

If you don’t have a secure yard, are you prepared to walk your dog at least 3 times a day on a secure leash – sun, rain, or snow?

Yes

Where will your dog be kept during the day?

Where will your dog be kept during the night?

What is the maximum amount of time your dog will be without a responsible person to take care of him/her while you are away?

What will you do if you are gone longer than your normal routine?

Do you have an active lifestyle that you would like your pet to be part of? If yes, please explain what that would include.

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Potsdam Humane Society Adoption Application

Personal Information

Housing Situation

Employment Status

Applicant

Co-Applicant

Current Situation Information

Past and Present Pet Information

Animal Welfare Information

Additional Information

Thank you for offering a home to an animal in our care.

Extra Dog Adoption Questions

Potsdam Humane Society Adoption Application

Personal Information

Housing Situation

Employment Status

Applicant

Co-Applicant

Current Situation Information

Past and Present Pet Information

Animal Welfare Information

Additional Information

Thank you for offering a home to an animal in our care.

Extra Dog Adoption Questions

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