Application

Home
Adoption
Volunteer/Donate
Events
Contact

Home
Adoption
Volunteer/Donate
Events
Contact

menu close

ELK COUNTY HUMANE SOCIETY

Home
Adoption
Volunteer/Donate
Events
Contact

Adoption Application

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

How long have you lived at your current address? *

This is a *

Home Apartment

Do you *

Own Rent

If renting, what is your landlord's phone number? *

Do you plan on moving soon? *

Yes No

Are you over 18 year of age? *

Yes No

Are you open to a home visit? *

Yes No

Where are you employed? *

What are your working hours? *

Full Time Part Time Unemployed Retired

How many adults and children live in your home? Please specify each individually. *

If there are children in the home, how old are they? *

Will family or friends come to visit with their own children and/or pets? *

Is anyone in the household allergic to animals? If yes, what kind(s) of animals? *

For whom are you adopting this pet? *

Self Family Gift

Have you ever adopted a shelter before? If yes, where and when? *

Who will be the primary caretaker of this pet? *

Where will this pet be kept? *

Inside Only Outside Only Freely Roaming Inside and Outside

If interested in a dog, how will you keep this pet confined to your property? *

Fenced In Yard Run/Tie Out Leash Walked Training N/A

How many hours per day will the pet be left alone? *

Never/Rarely 4 to 8 Hours 10 to 12 Hours 12+ Hours

Where will this pet be kept when alone? *

Where will this pet sleep at night? *

Have you ever given up a pet for any reason? If yes, please explain. *

Have you ever had a pet hit by a car? *

List any pets you own the present time. Please specify species, breed, gender, and ages. *

Can you provide proof of rabies vaccines for your current pets? *

Yes No No Current Pets

Are your current pets spayed/neutered? *

Yes No Not All of Them No Current Pets

Where are your current pets kept? *

Inside Only Outside Only Freely Roam Inside and Outside Some Inside, Some Outside No Current Pets

List any pets you've had in the last 5 years. Please specify species and breeds. *

Were these pets spayed/neutered? *

Yes No Not All of Them No Pets in the Past 5 Years

Veterinarian's Name *

Veterinarian's Phone Number *

Will you give us permission to contact your veterinarian as a reference? *

Yes No I do not have a current veterinarian.

Whose name are the records under? *

If you do not have a vet, please list 3 non-family references and phone numbers *

What kind of personality, breed, or other traits are you looking for in your newly adopted pet? *

Which animal(s) are you interested in adopting? *

By submitting this application, I agree that all the information provided in this form is accurate and true to the best of my knowledge.

Submit

We Would Love to Have You Visit Soon!

Hours

12 PM - 4 PM
Mon, Tues, Thurs, Fri, Sat

Telephone

(814) 834-3247

ADDRESS

Email

1029 East Eschbach Rd
St. Marys, PA, 15857

[email protected]