1. How long at the above address

2. What type of pet are you looking for? Dog Cat Puppy Kitten

3. Please check any of the following reasons for adopting this pet:

Family Pet Pet for Child  Watchdog Companion Breeding Hunting Dog

Guard Dog Barn cat/mouser Companion for other pet  Other

4. Are you or your spouse employed now? yes  no self retired

Tell Us about yourself...

6. Are you 18 years old or older? Do you live with your parents or other relative? yes no

7. Are you adopting for yourself Family Someone else?

8. Do you own your home? Rent?

Do you live in a house condo apartment Mobile home Duplex

9. Does your lease allow pets? yes no not sure

Are you aware of the cost of a pet deposit? yes no Can you pay it now? yes no

10. Landlord or apartment complex name

11. Do you have children in the home? yes not usually

12. Does any member of your household have allergies? yes no

13. Have you ever adopted a pet from HSGSC or other Humane Society? yes no

When

14. Have you ever turned a pet in to a Humane Society, Animal Shelter, or Animal Control?

yes no

Why?

15. Has a pet died on your premises within the last three months? yes no

How or why

16. Do you currently own any pets? yes no

Are they spayed or neutered? yes no   Are their shots current? yes no

17. Will this pet you are adopting live inside? outside?

Do you have a completely fenced yard? yes no Have a Dog pen? yes no

Is there a dog house? yes no

18. Would you object to an authorized representative of Humane Society of Griffin– Spalding County

inspecting the animal and the premises where the animal is being kept yes no

I agree that all the above questions have been answered truthfully.

Any misrepresentation on my part will result in forfeiture of  fees or donations

paid and surrender of the animal adopted.

Date Application Form submitted: Your Initials

If you have questions about filling out this application form, please contact us at 770-229-4925

Or email your questions to :  griffinhumanesociety@yahoo.com