W.C.H.S. Pet Resource and Adoption Center

Pre-Adoption Questionnaire

"Please read our Adoption Policies and Procedures before completing this Pre-Adoption Questionnaire."

Name:	Date:
Co-Adopter: Relationship:
Address: Box: Road Name:
City: State: Zip:
Phone: Fax: Email:

You may be surprised to find that adopting a pet is more involved than you expect. It is important to understand that the process is the same for everyone and it is not our intent to frustrate potential adopters. Everything we do is for the best interests of the animals in our care, and is aimed at giving them a second chance to find a permanent home. This form is designed to help our staff help you in choosing the best match.

HOUSEHOLD

Residence Type:

How long have you lived at this address?

Number of adults living in the home? Children? List children's ages:

Employment? Other Income? Are you a Student?

Will whole family meet with us at the shelter? Open to a home visitation?

Any household members have allergies to pets? Adopting this pet for?

Have you ever given up a pet for any reason?

Do you currently or do you plan to provide any kind of daycare for children?

Do other children or pets visit the home?

Who will be primmarily responsible for the care and supervision of the pet?

How long will this pet be left alone during the day?

Where will this pet be kept when alone?

Who will care for this pet when you have an emergency or go on vacation?

What rooms will this pet be allowed in?

What rooms will this pet not be allowed in?

Where will this pet be kept at night?

Usual weekend activities of family?

Do you need a current pet introduced to the animal your applying adopt?

Animal type your interested in? Animal name: Animal ID #

PLEASE LIST THE PETS YOU HAVE HAD IN THE LAST 5 YEARS:

Breed	Years Owned	Altered	Pet Status	Current Pets - health and age of your pet or Past Pets - what happened to your pet?

May we contact your vet?

Are you 21 or older: Do you certify that all your entries are true:

Questions, Comments, Suggestions, or Additional Information you feel we need to know:

AFTER THE FORM HAS BEEN PROCESSED, WE WILL CALL YOU COLLECT.
PLEASE INDICATE THE BEST DAY AND TIME FOR US TO CALL:

Warren County Humane Society is a non-profit business and can't be held responsible for typographical errors, invalid or out dated content or content that is linked to or from our web site. All offers, products and prices are subject to change without notice.