Thank you for considering an adoption of a Humane Alliance of Rutherford County Homeless animal. This form is designed to assist you in selecting a pet that is suitable for you and your family’s lifestyle so that you can be considered for an adoption today, you must be: 1.) 18 years of age or older, 2.) Have a current driver’s license or equivalent identification, 3.) If you rent or live with your parents, you must have permission from your landlord or parent to obtain and keep a pet on their property, and 4.) Understand that the adoption volunteer assisting you must approve your application for adoption.

1. Why would you like to adopt an animal today?______________________________________________________
2. When did you make the decision to adopt a pet?_____________________________________________________
3. Have you adopted a pet from the Humane Alliance before? Yes/No Dog/Cat
4. Do you own your home ________Rent ______Live with Parents ___________Other_________________ Name of Landlord/Parent______________________________ Tele. Phone_____________________
5. If you rent or live your parents, have you received their permission to keep a pet? Yes/No Is the pet the proper body weight? Yes/No
6. Who will have the ownership rights to the animal? You? _____Immediate Family?___________________ If Other: Identify by Name ___________________________________Address ___________________________________ City, State _______________________________ Phone ____________________________ Age______________
7. Age of children in the household__________________________________________________________________
8. Other pets you own that stay in the house or on the property_____________________________________________ Where do they live on the property?________________________________________________________________
9. Will the pet be kept indoors or outdoors? ____________________________How much time will the pet be indoors (if applicable)___________________________________Outdoors?______________________________________
10. Do you have a fenced in yard? Yes/No What means do you have to control your pet while outdoors______________
11. How long do you plan to keep this pet? ______________________________ How long did you have your previous pet?__________________________________ Identify breed type_______________________________________
12. Should you move unexpectedly, what will become of your pet? ___________________________________________
13. What behaviors would you consider unacceptable in your new pet? ________________________________________ How would you correct these behaviors?_____________________________________________________________
14. Do you have a veterinarian at this time? Yes/No If so, please identify by Name______________________________ Location______________________________ Tele. Phone (if known)________________________ Do you agree to obtain a veterinarian and establish a regular schedule of preventative medicine? Yes/No
15. If the animal should become ill or is injured, will you immediately obtain a veterinarian’s services to care for this animal? Yes/No
16. Have you read our adoption contract and do you approve of our methods of handling animals who become ill during our seven day examination period? Yes/No
17. If your pet is not spayed or neutered on the date of this adoption due to its age, will you have it spayed or neutered by its sixth month of age as required of this adoption? Yes/No
18. Do you agree to forfeit your spay/neuter deposit if the terms in number 17 above are not met? Yes/No
19. Do you agree to keep your pet on a leash while in your company out of doors and off your property as required by local and state leash law for both cats and dogs? Yes/No
20. Your adoption of a pet is a cash only transaction. Do you agree that your adoption fee will be refunded only at the discretion of the Humane Alliance? Yes/No

Signature of Adoptor ____________________________________________Date_____________________