Small Animal ApplicationTravis Drilingas2023-03-06T10:40:11-06:00 Small Animal Adoption Form "*" indicates required fields Name of Pet Date* Month Day Year Applicant Name* Date of Birth* Month Day Year Age*(Must be 21) Email Address*(No P.O. boxes) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Daytime PhoneCell PhoneEvening PhoneOccupation Employer Adopting a pet brings a lot of responsibility, including annual visits to the veterinarian, vaccinations, and possible emergency care. This is more expensive than many people realize. Are you aware of and prepared to assume the financial responsibilities for your newly adopted pet?* Yes No I currently*(Choose one) Own Rent Lease Property Type House Condo Trailer Apartment Other For how long? If you Rent or Lease, do you have your landlord’s permission to keep this kind of pet?* Yes No We must contact your Landlord prior to adoption.Landlord’s/Homeowner’s Name*(Must Provide) Landlord’s/Homeowner’s Phone*Do you currently live with family or friends?* Family Friends No For how long?* How many other people live at your residence?* List*NameAge Add RemoveAs an adult, have you owned a pet?* Yes No What type of pet?* What happened to him/her?* Do you currently have other animals?* Yes No List*NameType/BreedAgeSexSpayed/Neutered (Yes or No) Add RemoveIf you have not spayed/neutered your animal please explain why not.*Veterinarian(Must be provided)Veterinarian's Name* Veterinarian's Phone*PermissionI give my permission for the Humane Society of Calloway County (HSCC) to contact my veterinarian in order to verify that I have acted responsibly concerning the medical care for my animal in both consistency and in financial good standing. I agree with the terms.Is this the vet that saw your past/current pets? Yes No Past Veterinarian's Name* Past Veterinarian's Phone*Pet CareAre you aware of the shots required for your pet?* Yes No Are you aware that all animals adopted from HSCC MUST be spayed or neutered with NO exceptions?* Yes No What are you prepared to spend on your pet yearly?*(vet care, food, groom, heartworm/flea/tick prevention) I am aware of the basic care requirements for this particular animal*(health, diet, amount of cage space, litter used, grooming, socialization, dental care if applicable) Yes No I feel that I need further education in how to care for this animal.* Yes No I have or have had other animals of this same breed.* Yes No Where are they kept?* I am aware that small animals can be considered prey for larger animals, and agree to provide a safe environment for this pet.* Yes No I agree to have this animal altered or kept away from animals of the opposite sex. I will not be breeding this animal at any time.* Yes No This pet will live:* Indoors Indoors/Outdoors Mostly Outdoors Outdoors In a Cage Outdoors In a Barn Other My Information is Correct* I acknowledge that all of the information on the Entire Application and Contract is True and Correct.Signature*Date* Month Day Year We Reserve The Right, In Our Sole Discretion, To Refuse Any Applicant. It is for the benefit of our animals. The HSCC appreciates your consideration for wanting to provide a loving home for an animal in need.You must be at least 21 to submit this application Δ
