Elk County Humane Society

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Elk County Humane Society Adoption Application

First and Last Name
Address
City
State
Zip
Phone Number
Email Address
How long have you lived at your address?
Is this a:
- House?
- Apartment?
Do you:
- Own?
- Rent?
If renting, what is your landlord's phone number?
Do you plan on moving soon?
- Yes
- No
Where are you employed?
Working Hours:
- Full Time
- Part-Time
- Daytime
- Evenings
- Nights
- Weekends
- On Call
Do you receive:
- SSI?
- Disability Income?
- None
Do you plan on or currently provide any kind of daycare for children?
- Yes
- No
Is anyone in the household allergic to animals?
- Yes
- No
If yes, what kind(s) of animals?
Are there children in the home, if yes how old?
For whom are you adopting this pet?
Who will be the primary caretaker of this animal?
Will this pet be kept:
- Inside?
- Outside?
How many hours will this animal be left alone?
Where will this pet be kept when alone?
Where will this pet be kept overnight?
How will you prevent him/her from NOT going in certain areas of the house?
How will you keep this pet confined to your property?
Have you ever given up a pet for any reason? (Please explain)
Did you ever have a pet hit be a car? (Please explain)
List any pets you own at the preset time:
Are these animals spayed/neutered?
- Yes
- No
- Not All of them
Are these animals kept:
- Inside
- Outside
- Both
List any pets you've had in the past five years:
Were these animals spayed/neutered?
- Yes
- No
- Not All of Them
Veterinarian's Name:
Veterinarian's Phone Number:
Whose name are the records under?
If you do not have a vet, please list 3 non-family references and phone numbers:
Who are you interested in adopting?
Send Message

Thank you so much for you application. We will be contacting you as soon as possible.

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Elk County Humane Society | 1029 East Eschbach Road | St. Mary's PA, 15857 | (814) 834-3247 | management@echumanesociety.org