Thank you for filling out our online application, you must be 21 or older to adopt. Please answer all questions in order to submit. What animal are you interested in? Applicant/Co-applicant Profile Your name Co-applicant name Your email Your telephone number Physical address Mailing address (if different)type N/A if same Drivers license number & state Do you own of rent your home? ownrent If you rent, have you paid all pet deposits? yesnonot applicable How long have you lived at this address? Any plans to move in the near future? yesno Family/Household Information How many adults in the household? Have all the adults in the household agreed to this adoption? yesno Ages of children in household (if none write none): Have the children had pets before? yesnoN/A Any allergies to pets? yesno if yes, explain. Why would you like to adopt an animal from us? Check all that apply. Companion for selfCompanion for childCompanion for another petCompanion for another household memberGuard/ProtectionGift Is this your first pet? yesno Do you currently have pets? yesno Please list current pets. Name, Breed, age, gender, Spay/Neutered? Have you ever given away or relinquished and animal? yesno If yes please explain. Veterinarian's Name & Phone New Pet Information It takes time for animals to adjust to a new environment. Are you prepared to allow the time needed for your new pet to adjust to your home? yesno Are you committed to providing a responsible home for your pet’s entire life (10+ years)? yesno If you have to move, what do you plan to do with your pet(s)? Who in the household will be the pets’ primary care giver? Where will the pet be kept during the day? At night? How do you plan to house train your pet? Do you have a fenced yard? yesno If no, how do you plan on containing your pet outside of your house? How many hours per day will your pet be left alone? What training techniques would you use if your pet: (Please be specific): Digging: Barking: Chewing: Separation Anxiety: Aggression: Failure to house train: Please Note Please understand that Home At Last Humane Societyis not a veterinary clinic and that this animal may be harboring a medical condition which is not apparent during its stay at the shelter. Should such a condition become apparent after adoption, you assume full responsibility for any related veterinary care. We strongly recommend that you take advantage of the free office visit included in the adoption, within two (2) weeks of adoption. By clicking the submit button below, you have stated that all information on this application is true to the best of your knowledge. Home At Last Humane Societyhas the right to refuse an adoption if it is found that information stated on the application has been falsified.