Humane Society of Kodiak Adoption Application

Are you interested in a dog or cat *

Is there a specific shelter pet you are interested in adopting

Have you adopted from the Humane Society of Kodiak before? *

If yes, who did you adopt and when?

I understand that there is a minimum of 24 hours waiting period on all adoptions. *

I understand the Humane Society of Kodiak reserves the right to refuse adoption to anyone *

I understand that the Humane Society of Kodiak will not adopt to persons who mislead or fail to provide complete, truthful and accurate information *

Personal & Family Information

Applicant's first name *

Applicant's last name *

Physical Street Address *

Mailing Address *

City *

State *

Zip Code *

Email Address *

Phone Number *

Applicant's employer *

Co-applicant employer

Number of adults in household *

Co-applicant first name

Co-applicant last name

Number of children in household and ages *

Does anyone in your household have allergies to dogs or cats? *

Is everyone in your household aware that you are planning to adopt a pet? *

Home Information

Do you own or rent your home? *

Please select your current residence type. *

Landlord's first & last name and phone number

(FOR DOG ADOPTION ONLY) Do you have a fenced-in yard? If so, what kind of fence?

If you answered "other" above, please explain:

Current & Past Pets

Do you currently have any pets in the household *

If yes, please list names, breed and ages of all pets in the household

Are all pets in the household current on their vaccinations? *

Are all pets in the household spayed or neutered/fixed? *

If any of the pets are not current on vaccines or spayed/neutered, please list who and explain why?

Pets have you owned in the last 5 years? If none, please enter "none" *

If they no longer live with you, what happened to them?

Adoption Information

Please check the main reason you plan to adopt a pet: *

If you are wanting to be put on our wait list, please describe in detail the type of pet you are looking for.

On average, how many hours per day will your pet be left alone? *

When inside, how do you plan to keep you pet? *

Where will the animal sleep? *

(FOR DOG ADOPTION ONLY) :If you do not have a fenced yard, how will you let the animal out?

(FOR DOG ADOPTION ONLY):Are there times when the animal will be tied/chained up?

For what reason(s) would you consider returning/giving up the animal? Please select all that apply *

Veterinarian or Clinic's Name

Veterinarian's Phone Number

Please provide the names, relationship to you and contact number of 2 personal references, they must NOT be relatives or live in your household. *

Is there any other information that you would like to provide along with your application?

Yes, I am 21 years or older *

I have read the foregoing and certify that the answers I have given are complete, true and not misleading in any way. I am authorizing you to contact landlords, associations, personal references and veterinarians. I understand that this application does not guarantee adoption approval. You are also aware that we cannot guarantee the health and temperament of the animal. *

How did you find out about us?