Adoption Application

Please understand that the Suffolk Humane Society is completely staffed by volunteers. Once the application is received you will receive notification within 72 hours to schedule a home visit, if approved. Suffolk Humane Society reserves the right to decide the placement of our animals. The adoption fee is $250 for puppies and $200 for adults plus a $5 processing fee if you choose to use a debit or credit card which includes spay/neuter/flea treatment and all age-appropriate vaccinations. Additionally, dogs are tested for heartworms and are on heartworm preventative. We do not keep applications on file. Each adoption requires a new application.

Date

Specific Animal's Name

Applicant Name

Street Address

Apt #

City

State

Zip

Driver's License #

State of Issue

Birth Date

Home Phone

Work Phone

Cell Phone

E-mail Address

I want a pet for:
FamilyGiftMyself

Work Status
Have a JobHomemakerStudentOther

How long would dog be alone at a time

Do all members of the household know about and want a new animal?
YesNo

Who will be the primary caregiver for the dog?

How many adults live in your household?

How many children?

How old are the children?

Please tell us about the children's experience with pets

Is anyone in your household allergic to dogs or cats?
YesNo

Do you live in a
HouseApartmentTownhouseMobile HomeOther

Do you
OwnRent

How long have you lived at your present address?

How many pets are allowed?

Any weight, size or breed restrictions?
YesNo

IF YOU RENT, WE WILL NEED TO CONTACT YOUR LANDLORD OR MANAGEMENT COMPANY

Please provide their name and telephone number

Do you have other pets at home?
YesNo

Are all pets up to date on vaccinations and spayed/neutered?
YesNo

Have you ever had to give up a pet?
YesNo

Please list Veterinarians with phone numbers for living or deceased pets in the last 10 years. If you do not have a veterinarian already, whose services will you use for your new dog? Out of town application will not be processed without phone numbers!

Do you have a fenced yard?
YesNo

Would dog be inside or outside??
InsideOutside

Under what circumstances would you give up your pet?
Damage FurnitureNew BabyChewingDiggingDivorceMovingHousebreaking ProblemsLife ChangeOtherNone

I am willing and able to make the necessary financial commitment to care for a pet by providing veterinary care, including routine vaccinations and proper nutrition, for the life of the pet.
YesNo

I understand that a pet can live 15 years or longer. After giving very careful thought and consideration to all the responsibilities of pet ownership and my future lifestyle commitments, I would be able to care for a pet for its entire lifespan.
YesNo

I certify that the above information is correct, and I understand that the Suffolk Humane Society has the right to verify this information.

Applicant Signature

Date

Upcoming Events:

Paws for the Arts 2025
March 1, 2025 @ 2:30 pm - 6:00 pm

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Adoption Application

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