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2025-01-08T23:41:47+00:00
Which animal are you applying to adopt?
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Cat
Dog
Today's Date
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Applicant Name
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Specific Animal's Name
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Street Address
Apartment, suite, etc
City
State/Province
ZIP / Postal Code
Driver's License #
State of Issue
Cell Phone
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Home Phone
Work Phone
Email Address
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Birthday
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I want a pet for:
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Family
Gift
Myself
Work Status:
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Have a Job
Homemaker
Student
Other
How long would dog be alone at a time?
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How long would cat be alone at a time?
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Do all members of the household know about and want a new animal?
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Yes
No
Who will be the primary caregiver for the dog?
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Who will be the primary caregiver for the cat?
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How many adults live in your household?
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How many children?
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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?
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Yes
No
Do you live in a
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House
Apartment
Townhouse
Mobile Home
Other
Do you
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Own
Rent
How long have you lived at your present address?
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How many pets are allowed?
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IF YOU RENT, WE WILL NEED TO CONTACT YOUR LANDLORD OR MANAGEMENT COMPANY
Do you have other pets at home?
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Yes
No
Are all pets up to date on vaccinations and spayed/neutered?
Yes
No
Have you ever had to give up a pet?
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Yes
No
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 pet? Out of town application will not be processed without phone numbers!
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Do you have a fenced yard?
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Yes
No
Would dog be inside or outside?
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Inside
Outside
Would cat be inside or outside?
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Inside
Outside
Under what circumstances would you give up your pet?
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Damage Furniture
New Baby
Chewing
Digging
Divorce
Moving
Housebreaking Problems
Life Change
Other
None
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.
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Yes
No
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.
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Yes
No
I certify that the above information is correct, and I understand that the Suffolk Humane Society has the right to verify this information.
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Yes
Applicant Signature
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Date
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Submit Application Form
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