Thank you for choosing to adopt from the Kitsap Humane Society! To ensure that KHS animals and adopters are properly
matched, we ask that you complete our adoption application before proceeding to a meet and greet. Animals at KHS are
homeless and for that reason, extra care is taken to place them in the best environments possible. In some cases, an adop-
tion may not be approved based on the best interests of the human or pet. By completing this adoption application, you are
requesting to meet a shelter pet. Kitsap Humane Society cannot guarantee the health status or behavior of the shelter pets
you meet during the adoption process. By completing this application and participating in an adoption counsel, you shall
agree to indemnify and hold harmless Kitsap Humane Society and its representatives from liability and claim for any damages
because of bodily injury, injury to your pet, sickness, or disease resulting from interactions with shelter pets during the adop-
tion process.
Last Name: ____________________________________________________ First Name: ______________________________ Date: ____________
Date of Birth: ______/______/_______ Spouse/Partner Name: ______________________________________________________
Home Address: (Street): _________________________________________________________________ Apt.#__________________
(City): __________________________________________________________ (State): _________ (Zip): ______________________
Mailing Address, if different: ___________________________________________________________________________________
Primary Phone: (_______) _____________________________ Secondary Phone: (_________) ___________________________
Email Address: _________________________________________________________________________________________________
Alternate contact (for microchip) Name: ________________________________ Phone: (_______) ______________________
Have you ever surrendered or returned an animal before? Yes / No
If yes, why?
When (approx.)? Dog or Cat? Have you adopted from KHS before?
Ages? Number of visiting children under 18 in home?
Are there elderly people in the home? Yes / No
Number of children under 18 in home?
If you RENT, have you checked with your landlord about pet restrictions? Yes / No
Do you know if this animal is permitted? Yes / No
Number of adults in home?
I plan to move inDo you: Rent / Own / Live with relative H ow long at this address?__________ ________
___________ ___________________________________________________________________
_______________ _______________________________________________________
_________ ________________ ____________________________
Now please tell us about your current living environment as it applies to a new animal family member.
Please tell us about your current and past pets:
Dog / Cat Age Breed M / F?
Length of
Is this animal
sll in your
care? If no, why?
Y / N
Y / N
Y / N
Y / N
See Other Side!
Are you prepared to adopt an animal today? Yes / No If no, why?_____________________________________
Are you a current KHS Volunteer (volunteered in the last 3 months)? Yes / No
Housing and Behavior:
1. Will your pet be housed indoors or outdoors when you are not home?________________________________________
2. How many hours a day will the pet(s) be left alone? ____________________________________________________
3. What would cause you to return or rehome this animal? ________________________________________________
4. How much do you expect to spend yearly on this pet (food, boarding, medical care, toys, training, etc)?
(select one): $100 $500 $1000 More
5. My household is: active & noisy OR mostly quiet & calm
6. What characteristics do you hope to find in an animal companion?____________________________________________
7. For which potential behaviors would you like more information? (select any that apply)
Biting/scratching Chewing Excessive vocalizing House soiling Not good with children
Escaping Introducing to another pet Other:
8. Are you familiar with this breed? Yes / No With this age of animal? Yes / No
For DOGS only:
A. Do you have a yard? Yes / No Approximate size of yard: ________feet by ________feet
B. Is it fenced? Yes /No Type of fence: ______________________ Height of fence: ______________________
i. How will you keep the dog in your yard? ___________________________________________________________
C. What is your exercise plan for the dog?________________________________________________________________________________
D. What is your strategy for addressing behavior issues?
E. Do you hope to take your dog to dog parks? __________________________________________________________________
For CATS only:
A. Are you planning on declawing this cat? Y / N If yes, why?________________________________________________________
B. Would you like info on how pregnant women can handle kitty litter safely? Y / N
C. Are you familiar with FIV and FeLV testing for cats? Y / N
I certify that the above information is true. I understand that giving false information on this application is grounds for deny-
ing my application. I understand that this application remains the property of Kitsap Humane Society.
Signature___________________________________ Drivers License: __________________________________________
Internal Use Only:
Approved for ID# ______________Name _____________________ Counselor Notes:
___ Yes
___ Yes, pending Meet and Greet
___ Yes, pending surgery
___ No
Counselor ____________________________________________
Meet and Greet successful? Yes / No
Needs a cat carrier? Yes / No
Meds to go home? Yes / No
FeLV/FIV test? Yes / No
Counselor _______ _____________________________________
click to sign
click to edit