1. Why are you interested in adopting a pet from the Humane Society?

2. Will this be your first pet? (cat/dog)

3. Do you (or members of your household have any pet allergies?

4. Do you have other pets? What kind?

5. How much time will you dedicate to caring for your pet? (hrs/week)

6. Will you be able to provide proper veterinary care (e.g. vaccinations, spay/neuter, etc.) for this animal?

7. Do you rent or own your home?

8. (For renters) Do you have the permission of your landlord to adopt an animal?
(Permission will be determined through direct contact with landlord or by a copy of a lease that indicates that pets are allowed)
9. How long do you anticipate living at your current residence?

10. Will this pet be in contact with any individuals who may have compromised immune systems?

11. Do you have any children? What are their ages?

12. Will this dog be inside or outside? If outside, do you have a fenced yard or a kennel?

13. Will this cat be allowed outside?

14. Do you have any specific concerns or questions about adopting a pet?

Description of animal/Case#__________________________________________

SCHS Agent_______________________________

Date______________________________________