HUMANE SOCIETY OF JEFFERSON COUNTY
Adoption Application FAX# 865-475-8938
Name ___________________________________ E-Mail _________________________________
Address ________________________________ City __________________ State/Zip__________
Phone (H) _____________________________ Cell Ph ___________________________________
Please circle type of animal interested in adopting: Dog Puppy Cat Kitten Other _____________
Have you ever SURRENDERED a pet to a shelter or rescue? ___________________
Nome of Veterinarian _____________________________ Phone # of vet ___________________
Do you live in? Apt. Condo Single/Doublewide House Do you own or rent? __________
List all the animals currently in the household or on property (even if not owned by you)
Type of animal Age Sex Spayed/Neutered
_______________ _______ _______ _________________ Please use back of
_______________ _______ _______ _________________ sheet for additional
_______________ _______ _______ _________________ animals
Why do you want this animal? Companionship Protection Breeding Show Other
Do you plan on keeping the animal inside or outside: __________________________
If outside, how do you plan to contain the animal: fenced yard kennel lot chain none
Are you aware of the necessity of vaccines and heartworm preventatives for cats and dogs? ___
Are you aware of state/local ordinances (leash laws, rabies vaccinations, shelter, food, water)? ___
How did you find out about the pet you want to adopt? _________________________________
I acknowledge that all the information on this form is true and correct.
(If any information is found to be false, the Animal Shelter will not adopt any animal to you now or in the future, If the animal has already been adopted, the Animal Shelter reserves the right to have Animal Control come to your home and remove the animal.)
Applicant’s Signature: _______________________________________ Date: ________________
Adoption Counselor’s Signature: _______________________________ Date: ________________