PO Box 233, Avon, NY 14414
Phone: (585) 234 -2828

Email: HSLC198704@yahoo.com

Web address: www.hslcny.org

 

ADOPTION APPLICATION

Message from the Humane Society of Livingston County:

     Thank you so much for your support. By adopting your new best friend from the HSLC you are supporting our mission to aid in prevention of animal abuse, overpopulation, and suffering within our community and you have become a vital part of our program success. We hope you have many happy years together with your new friend. We also hope you will continue to show your support for the HSLC.  To ensure that the animal you want to adopt is best suited to you and your home please provide the following information. Thank you.

 

Adopter’s Name: ________________________________________________________________

 

Current Address: ________________________________________________ Apt#____________

            

City: _________________________________________ State: ___________ Zip: _________

 

Phone #(Home) ______________(Work) _____________Email address______________________

 

Do you Own _____  Rent _______ May we contact your landlord? Yes____ No_____

Landlord contact Information…Name ______________________________Phone#_____________

How long have you lived at the above address? ____________

May we contact your Veterinarian?     Yes_____  No______

What is the name of your Veterinarian, Veterinary Hospital?

 _______________________________________________________Phone #_____________

 

How many adults are in the household? ______  Children and their ages? ___________________ 

Reason for wanting this pet:

Family Companion  ___   Gift  ___ Mouser  ___ Guard Dog  ___ Hunting  ___For my Children____

Personal Protection  ___Companion for other animal ___  Other (Specify)___________________

 

Where will pets living quarters be? ________________________________

If you are adopting a dog, how will the dog be restrained when it is outside?

Chain  _____Runner Line  _____Leashed-walks only  _____Fenced Yard ________

 

In the past 5 years, what pets have you owned?

X if still

Owned

 

Cat or Dog?

 

Name

 

Age

 

Sex

Licensed?

(if dog)

Spayed or Neutered

If No Longer Owned What Happened ?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ANIMAL ADOPTION INFORMATION

 

 

Dog_____ Cat______ Sex_______ Age (if known)_______ Name (if known)_______________

 

File No.___________ Description________________________________ Breed ___________

 

 

Since my new pet comes from HSLC, I understand others have already invested, both emotionally and financially, in his/her welfare. I acknowledge this involvement and therefore agree to continue their commitment by:

  1. Having the knowledge that by spaying and neutering my pet my individual effort can help reduce overpopulation and knowing this I will agree to have my pet spayed or neutered
  2. Working in partnership with my veterinarian to provide proper care, which will include seeing that all necessary vaccinations and treatments are given on schedule.
  3.  Providing an environment that will ensure a life free of traffic hazards, harsh weather, human cruelty and communicable diseases.
  4. Providing proper hygiene care and playtime, including grooming, nail clipping, ear and teeth cleaning (if recommended by vet).
  5. Resolving that decisions about where I chose to live will always include, and allow for animal ownership for this new family member.
  6. Making sure that arrangements are in place in the event of my death for the placement and care of my animal(s).

 

Furthermore, I promise to contact the HSLC in the event circumstances beyond my control make animal ownership impossible. This will enable me to work with them to find another home for my friend.

 

By signing I affirm that I am 21 years of age or over, and that the

information contained on this form is true to the best of my knowledge.

I understand that if approved for adoption, I am prepared to make

a lifelong commitment of time and money to my pet.

 

Signature: ______________________________________ Date: __________________

 

Adoption fee_____________________________________________________________________

 

 

Text Box: HSLC USE ONLY Application Received on ________________________ Finalized on______________________ HSLC’s Witness of Adoption: ________________________________________________________ Comments _______________________________________________________________________ ________________________________________________________________________________  

 

 

 

 

 

 

 

 

 

 

 

 

 


HSLC Adoption Agreement Outline

 

 

By signing the HSLC Contract, I agree to the following stipulations:

·                    Veterinarian Care

·                    Inside Kitty Only

·                    No Declawing

·                    Kitty Will Be Neutered

 

 An HSLC member can always stop in to see kitty when in the

  Area

 

  I agree to the adoption rules

 

  Signed:              ____________________________________

 
  Date:                   ____________________________________


  HSLC Witness:  ____________________________________