I have read, and understand, the handouts "Our Adoption Process," "Shelter Standards," and "Cat and Dog Adoption Policies." (Please initial here) ________

Where did you hear about us? __ TV __ Newspaper __ Friend __ Radio __Other ______________

Dr. | Mr. | Mr/Mrs | Ms. | Mrs. _______________________________________________ Date________________

Mailing Address_____________________ City ____________ State _____ Zip ________

Street address______________________ City ____________ State _____ Zip ________

Home Phone ___________________ Work Phone _______________

Driver's License # or Other Identification________________________________________________
Exp Date: MM/DD/YR_______________________

Are you 18 years of age or older? Yes ____ No ____

Describe the type of pet you think would fit in best with your family:_______________________________
____________________________________________________________________________________

Why do you want to adopt an animal? Please check any of the following that apply:

Will this be your first experience with a pet? Yes ___ No ___

Have you ever adopted an animal from the Sequoia Humane Society? Yes ___ No ___

How long have you lived at the above address? ____________

Do you: Own ____ Rent ____ Live with parents ____
In a: House ____ Apartment ____ Mobile Home ____ Condo____

Does your lease allow pets? Yes ___ No ___
What is your landlord's name and telephone number?
Name_______________________________________ Phone number__________________

Does your landlord know that you are planning to add a new pet to your household? ___ Yes ___ No
Will you be charged a deposit or have your rent raised when you adopt an animal?   ___ Yes ___ No

How many adults are in your household? ____ How many children? ______ Ages of children? ____________

Do all members of your household know that you plan to adopt a pet? Yes ___ No ___

Are you planning to move within the next six months? Yes ___ No ___
If you do have to move unexpectedly, what will you do with your pets?________________________________
______________________________________________________________________________________

Does anyone in the household have allergies to animals? Yes ___ No ___

Pets are an investment of time and money. Are you prepared to provide medical care, grooming, proper diet, shelter, training and exercise for your new pet? ____________________

Are you willing to make a long-term commitment to care for your pet for its lifespan, which could be 10+ years? _________________________________________________________________

What is your attitude toward spaying and neutering pets?_______________________________________________
___________________________________________________________________________________________
Do you agree to have this animal spayed or neutered? Yes ___ No ___

What is the name of your veterinarian? _____________________________________________
May we contact your veterinarian to verify records? Yes ____ No ____

Please list other pets you now own, or have owned in the past five years:

Will your pet be left alone during the day? Yes ___ No ___ For how long? ______________________
Is there someone who will be responsible for your pet when you're away for long periods of time, or are unexpectedly unable to return home at a regular hour? Yes___ No ___

Where will your pet be kept during the day? _____________________ At night? _________________________

What would you do if your new pet develops attitude or behavior problems? ___________________________

Did you know that you could call us for advice on how to solve attitude or behavior problems? Yes___ No ___

If this pet is for a child, what will you do if the child stops caring for it?_________________________________
_________________________________________________________________________________________
 

For Dog Adoptions Only:
Consider the size of your pet when it is an adult. How will you ensure he/she receives proper exercise? _______________________________________________________

Is your yard securely fenced? ___ Yes ___ No
Type of fence ___________________ Height of fence ____________________

How will you assure that your pet is confined to your property? (Note: If your pet escapes and is impounded, you must pay a fine that could be $100 or more to get it back.)______

Under what circumstances would you ever allow your dog to run free?____________________________
_________________________________________________________________________________________

Are you familiar with the laws governing the ownership of animals, such as leash laws, vaccination and licensing requirements, humane laws, etc? ___ Yes ___ Need info

Please let one of our Shelter Representatives know that you have completed this application and are now ready for the next step in our adoption process: viewing the video tape and having a conversation with one of our adoption counselors.