Humane Society of Kodiak Adoption Application
Are you interested in a dog or cat
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Dog
Cat
Both
Is there a specific shelter pet you are interested in adopting
Have you adopted from the Humane Society of Kodiak before?
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No
Yes
If yes, who did you adopt and when?
I understand that there is a minimum of 24 hours waiting period on all adoptions.
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No
Yes
I understand the Humane Society of Kodiak reserves the right to refuse adoption to anyone
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No
Yes
I understand that the Humane Society of Kodiak will not adopt to persons who mislead or fail to provide complete, truthful and accurate information
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No
Yes
Personal & Family Information
Applicant's first name
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Applicant's last name
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Physical Street Address
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Mailing Address
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City
*
State
*
Zip Code
*
Email Address
*
Phone Number
*
Applicant's employer
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Co-applicant employer
Co-applicant first name
Co-applicant last name
Number of adults in household
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Number of children in household and ages
*
Is everyone in your household aware that you are planning to adopt a pet?
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Yes
No
N/A
Does anyone in your household have allergies to dogs or cats?
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Yes
No
Possibly
N/A
Home Information
Do you own or rent your home?
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Own
Rent
Military Housing
Please select your current residence type.
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House
Apartment
Condo
Townhouse
Mobile Home
Other
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?
Wood
Chain Link
Electric
Plastic
Iron
Other
Other (I do not have a fenced yard)
No fenced yard
If you answered "other" above, please explain:
Current & Past Pets
Do you currently have any pets in the household
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No
Yes
If yes, please list names, breed and ages of all pets in the household
Are all pets in the household current on their vaccinations?
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Yes
No
Unknown
Are all pets in the household spayed or neutered/fixed?
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Yes
No
Unknown
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"
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If they no longer live with you, what happened to them?
Adoption Information
Please check the main reason you plan to adopt a pet:
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Companion
Family Pet
Child's Pet
Guard Dog
Companion for another pet
Other
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?
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2-4 hrs
4-8 hrs
8-12 hrs
12+ hrs
None
When inside, how do you plan to keep you pet?
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Free inside house
Confined to crate
Inside a closed room
Other
Where will the animal sleep?
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In bed with me
In bed with my child
In a dog / cat bed
In a kennel / crate
Wherever he or she likes
Outside
(FOR DOG ADOPTION ONLY) :If you do not have a fenced yard, how will you let the animal out?
Are there times when the animal will be tied/chained up?
Yes
No
N/A
For what reason(s) would you consider returning/giving up the animal? Please select all that apply
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Moving
Job
Kids
Too Busy
Divorce/Separation
New Baby
Vet Care
Pet Too Big/Too Small
Bad Habits
Bit Someone (provoked)
Bit Someone (unprovoked)
None
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.
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Is there any other information that you would like to provide along with your application?
Yes, I am 21 years or older
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No
Yes
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.
*
Yes
No
How did you find out about us?
Petfinder
Internet Search
Family/Friend
Staff/Volunteer
Facebook/Twitter
Other