HUMANE SOCIETY OF MARION COUNTY, INC.

701 NW 14^th Road, Ocala FL 34475

Phone: (352) 873-PETS   Fax: (352) 854-9187

  ADOPTION APPLICATION

  The Humane Society’s application and interview process is designed to help our adoption counselors determine if the animal you have chosen will be compatible with your family and lifestyle.  Our mission is not to simply move animals out the door, but to ensure that each animal’s placement is in its and your best interest.  The welfare of each animal in our care is our foremost consideration; therefore, the Humane Society reserves the right to refuse adoption to anyone for any reason. The requirement of adequate facilities to maintain and contain the animal must be met and a satisfactory home visit may be required before the application will be approved.

 Potential adopters must:

·        Be at least eighteen (18) years of age

·        Have a picture identification that shows current address (i.e. driver license)

·        Have written permission from landlord (if renting)

·        Be willing to invest the time and money necessary to provide proper care, medical treatment and training for your pet on a long-term basis

 Adoption fee includes:

·        Spaying or neutering of the animal

·        Age appropriate vaccinations, including rabies

·        Heartworm test on dogs over six (6) months of age

·        Feline Leukemia test on all cats

·        Microchip implantation and registration

·        Free visual examination by a participating veterinarian

·        A seven (7) day health return policy (see Adoption Agreement).  After the seven (7) days, adopted animals are the sole responsibility of the adopter.

     I have read, understand and agree to all terms of acquisition.

                                                  __________________________________________________________

                                                      Signature                                                          Date

DOG ADOPTION ONLY

 What is your reason for choosing to adopt a dog? (Check all that apply)

____ House Pet                           ____ Companionship                     ____ Company for Other Pet

____ Watch/Guard Dog               ____Gift                                          ____ Other:__________________

Where will this dog be kept during the day?______________________________________________

Where will this dog be kept during the night?______________________________________________

How many hours per day will the dog be left alone/without human companionship?_______________

Where will the dog be kept when alone?___________________________________________

Are you aware that your new dog will need to be house trained? 0Yes 0No 

Are you familiar with crate training?   0Yes 0No     

What are your feelings about it?_________________________________________________

How do you plan on keeping the dog confined to your property?    

0  Inside House            0  In Garage                0 Fenced Yard           0 Outside Kennel           0 Patio

0  On Chain                 0  On Leash                0 On Cable    0  Other___________________________

Do you have a fenced yard?     0Yes 0No                   

Will it safely contain a dog?  0Yes 0No 

If yes, what type?   0 Chain Link             0 Wire          0 Privacy         0 Three Board

Other:__________________________________________________________________

If your dog will be kept outside for any length of time, are you aware that you will be required to

 provide it shelter from the elements?   0Yes 0No   

What type of shelter will you provide? ________________________________________

Do you plan on having this dog’s ears cropped, tail docked or debarked?  0Yes 0No 

 What will you do if this dog chews furniture or shows other types of destructive behavior?

________________________________________________________________________

Do you plan on providing this dog with obedience training?  0Yes 0No 

Do you or anyone living in your household have any known allergies to animals?  0Yes 0No 

If yes, to what kind(s) of animal(s):___________________________________________

How severe is the allergy?__________________________________________________

Are you aware that this dog will require:

            Annual vaccinations and tests?                      0Yes 0No 

            Annual rabies vaccination?                             0Yes 0No 

            Marion County license?                                  0Yes 0No 

            Monthly flea/tick control?                                0Yes 0No 

            Monthly heartworm preventative?                     0Yes 0No 

            Are you aware of heartworm disease?              0Yes 0No 

            Are you familiar with Marion County’s leash laws?    0Yes 0No 

 What concerns or questions do you have about adopting a dog?_____________________________________

Name: __________________________________________________________________________

 Address: ________________________________________________________________________

 City: ____________________________________________ State: _________  Zip: ____________

 Home ph. # _________________ Work ph. # _________________ Cell ph. #  _________________

 Place of employment ______________________________________________________________

 Driver’s License # _____________________________________ State ______________________

 Please describe your residence:

 _____ house                         How long have you lived at the above address? ________________

_____ apartment                  How many people live in your household? ____________________

_____ condo                         How many are children? ________ Ages _____________________

_____ mobile home             Do all adults know that you plan to adopt:? ____________________

_____ duplex             Who will be responsible for the care of this pet? ________________

_____ other                           In an emergency, who will be responsible? ____________________

 Do you _______ own or ______ rent?      If you rent, please provide the following information:

                                                                        Property owner’s name: ________________________

                                                                        Property owner’s ph #: _________________________

 What pets do you currently have in your household?

Cats: ________ Ages: _____________    

Dogs: ___________  Breed/Ages: ________________________________________________

Other: ____________________ Ages: ______________________

Are your animals spayed or neutered?  ___ yes  ___ no  Current on vaccinations? ____yes ____ no

Who is your veterinarian? ____________________________ Phone # ______________________

Last date your pets were seen by the veterinarian?  Month _____________ Year ______________

List other pets owned by you in the past 5 years other than those above:

            Type                Spayed/Neutered     Kept Where     Time Owned          What Happened To Them

Dog ___ Cat ____    Yes____ No____       In ___Out___    __________         ____________________

Dog ___ Cat ____    Yes____ No____       In ___Out___    __________         ____________________

Dog ___ Cat ____    Yes____ No____       In ___Out___    __________         ____________________

Dog ___ Cat ____    Yes____ No____       In ___Out___    __________         ____________________

 FOR SHELTER USE ONLY – DO NOT WRITE BELOW THIS LINE

Landlord Approval ____________________________________________Date:_________________

Home Visit Approved __________________________________________Date:________________

Adoption Counselor Notes:___________________________________________________________

________________________________________________________________________________

                                                                                       ____________________________

                                                                                          HSMC REPRESENTATIVE

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