ADOPTION APPLICATION  with JASPER LAKES AREA HUMANE SOCIETY

Your Name: ________________________________________

Address: __________________________________________

 
Home Phone: ______________________________________

 
Work Phone: _______________________________________

 
Best Place/time to Call: ______________________________

Occupation: _______________________________________

Personal References: _________________________________________________________

Name & Phone # of your Regular Veterinarian: ____________________________________

Do you live in a (circle one): house, apartment, condo, trailer, other

Do you rent or own your home? __________________

 
If renting, do you have your landlord's permission to
keep an animal? __________________

 
Landlord's Name and number: _________________________________________________

How many adults in your family: __________________

 
How many children are in your household, include age and sex:

 __________________________________________________________________________

What kind of companion animal are you looking for:

 
species? __________________  breed? __________________

 
sex? __________________  age? __________________

inside or outside pet____________________ Do you have a fenced yard?____________

 
Who will be responsible for the primary care of the animal? _______________________

Who will provide care for the animal when you travel or

 
during emergencies? _______________________________________________________

 
List the animals currently in your home, breed, age, sex: _________________________

__________________________________________________________________________