Have you ever brought an animal to an animal shelter under any circumstances? □YES □NO
what was the reason? _____________________________________________________________________
Including yourself, please list the NAMES and AGES of all members of your household:
Name of your Veterinarian or Veterinary Hospital_________________________________________________
PET HISTORY: In the past 5 years, what pets have you owned (include those pets that have passed)? What
pets do you have currently in your home? Please include all animals at the residence whether you own them
or not. Also, include any small caged pets & barnyard animals.
If no longer owned, what happened
to the pet?
Do you object to the Humane Society inspecting your premises? □YES I DO □NO I DO NOT
Please check ALL the following topics you would like to discuss with the Adoption Counselor:
□ Cost □ Digging □ Introducing other pets □ Jumping
□ Barking □ Vaccinations □ Indoors vs. Outdoors □ Crate Training
□ Housebreaking □ Obedience Training □ Declawing □ Feeding
□ Exercising □ Introducing Children □ Litter training □ Scratching Objects
□ Other _________________________________________________________________________________
THERE ARE SOME DAYS THAT THE ADOPTION PROCESS CAN TAKE 1-2 HOURS:
You will be talking to
our staff or volunteers, meeting and socializing with the pet you are interested in, reviewing the responsibilities that you
will assume, and learning about inoculations, training, food, etc. All of this can take time, but it is time well invested,
considering that a well-cared for dog or cat may live 10-18 years! Therefore, we ask for your patience and cooperation in
this joyful process of bringing people and animals together.
I HEREBY RELEASE TO THE GULF COAST HUMANE SOCIETY, INC. ALL VETERINARY RECORDS OF ANY AND
ALL ANIMALS I OWN OR HAVE OWNED. I CERTIFY THAT I AM 21 YEARS OF AGE OR OVER AND THAT ALL THE
INFORMATION IN THIS APPLICATION IS TRUE AND I UNDERSTAND THAT FALSE INFORMATION OR
UNANSWERED QUESTIONS MAY VOID THE APPLICATION. I ALSO UNDERSTAND THAT THE GULF COAST
HUMANE SOCIETY RESERVES THE RIGHT TO DENY ANY ADOPTION APPLICATION.
SIGNATURE ____________________ DATE
STAFF USE ONLY:
□ VET CHECKED □ LANDLORD CHECK □ ADOPTER CHECK Counselor Initials ________________________________
□ APPROVED □ DENIED (specify reason) □ PENDING □ PLACED ON HOLD until ________________________________
ANIMAL ID # ____________________ ANIMAL NAME ____________________________________________________________________
Comments: __________________________________________________________________________________________________________
__________________________________________________________________________________________________________________
