Humane Society of the Palouse Canine Pre-Adoption Application WE RESERVE THE RIGHT TO DENY ANY ADOPTION WE FEEL UNSUITABLE. In order to be considered for adoption you must: 1) Be 18 years of age 2) have the knowledge and consent of all the adults living in your household 3) have a valid id and proof of current address 4) understand that completing this application does not guarantee adoption and that the Humane Society of the Palouse has approved your application. Animal information: HSOP #______ The animal being considered for adoption by you is being placed as an indoor house cat unless otherwise specified in writing: Dogs name: _____________________ sex:________ Breed:______________________ age:_________ Description: ___________________________________________________________________________ Household information: Please print all information Adopter(s) ____________________________________________________________________________ Address________________________________________ City__________ State ________ Zip_________ Mailing address__________________________________ City_________ State_________ Zip_________ Phone number: home____________________________ Work ________________other____________ Drivers license #_____________________State _____E-mail: __________________________________ Housing (circle all that apply): own / rent / live with parents house/ condo / apt / mobile on leased land/mobile on owned land Landlord name:________________________________ phone #:________________________________ How long have you lived at this address?: ________ Do you have roommates:_____________________ If yes, do they all know and are in agreement of you adopting an animal? _________________________ Are there children living at this address? _______ If yes, what are their ages_______________________ Are you planning on moving in the near future?_______ If at some time you do move, what will you do with your pet_________________________________________________________________________ Why do you want to adopt a dog? Companion for a person______ If yes what age? _______ Companion for another animal________ Protection ________ Jogging/walking buddy________ Hunting______ Couch warmer_________ Do you have a fenced yard? _________ Fenced on all sides? ________ How tall? ________________ Continuation of Canine Pre-Adoption application If you don’t have a fence how will you keep your new dog confined to your property________________ If using a chain or a tie out how many hours of the day will the dog be on it?_________ Where will your new dog spend its days? (Circle all that apply) Indoor / Outdoor / Basement / Kitchen Garage / Porch / Shut in room/Crate Where will your new dog spend its nights? (Circle all that apply) Indoor / Outdoor / Basement / Kitchen Garage/Porch / Shut in room/Crate Are you familiar with trimming dog’s claws? _____ Would you like to learn? _________ Are you willing to provide toys and raw hide chews to prevent problem chewing? ___________ Do you have any animals now? ___ Species:_________ Sex:_________ Fixed: ________Age:______ Species:_________ Sex:_________ Fixed: ________Age:______ Species:_________ Sex:_________ Fixed: _______Age:_______ Species:_________ Sex:_________ Fixed: ______ Age:_______ Who is your veterinarian? _____________________________ Phone #:__________________________ Have you gotten rid of any animals within the last year? _______ Or have you had any animals pass away for other than medical reasons? _______ Please describe circumstances? _______________________________________________ Signature____________________________________ Date___________________________________ If you could please answer the following questions that would be greatly appreciated How did you hear about The Humane Society of the Palouse?___________________________________ Have you adopted from our facility before?______________________________________________