Adoption Application

**Must be a minimum of 18 years old to adopt**

First name *

Last name *

Address *

City *

State *

Zip *

Email *

Cell phone *

Home phone

What type of pet are you interested in?

Name of pet you are interested in meeting

How experienced do you feel you are with providing veterinary care for your pet? *

How experienced do you feel you are for caring for this type of pet? *

Please supply us with your current vet's information, including their address and phone number. *

How would you describe your household? *

Do you rent or own your home? *

If you rent, please supply your landlord's name and phone nubmber. If you live in an apartment, please supply your apartment's name and the manager's name and phone number.If you own your home, please type "none". **If the manager/landlord information is not provided (for renters), the application will not be approved** *

Please tell us about the other dogs and cats currently living in your home. Please include name, pet type, age, spayed/neutered and vet/clinic info. *

Please tell us about any animals you have had in the past, including breed, age, spayed/neutered, etc.

What is your source of income? *

Please list a reference (name & number) not related to you. *

I understand that:

Adopting a pet is a long term commitment
The Community Humane Shelter of Steuben County reserves the right to refuse/reject any application at its discretion
My electronic signature allows release of any information necessary to process this application
The Community Humane Shelter of Steuben County may perform a criminal background check as part of the application process.

Signature of applicant *