Renters: list your landlord’s phone number (_____________)______________
Adopter Profile
CAT OR DOG PRE-SCREEN FORM
REQUIREMENTS: 18+ Years of Age | Valid Photo ID | Provide Proof of Address | Pay Entire Adoption Fee Today
Are you over the age of 18? YES / NO
Full Name _______________________________________________
Home Address_____________________________________________________________________ Apt #_____________
City__________________________________________ State ____________________ Zip Code____________________
Main Phone (_____________)________________________ Email_____________________________________________
For office use only
Any falsification of information, not meeting required policies or laws, etc. may result in a denial of your application. For a full list of policies please see our website.
Have you ever had to rehome or give away a pet? YES / NO If yes, why ___________________________________________
Live with Parents: list your parent’s phone number (_____________)_____________
Do you:
Own
Rent
Live with Parents
Mobile Home
School Housing
Please Circle Your Answer
Will the pet live somewhere other than the address listed above on a regular basis? YES / NO
If yes, please list that address ________________________________________________
How many children live in your home? ___________ What ages? ___________________
Do you have visitors that are 17 or younger or animals in your home often? YES / NO
If yes, what ages of visitors or species of animals? ________________________________
Please list your current employer ______________________________________________________________________
By signing below, I certify that all statements and answers on this application and verbally given to the adoption counselor are true and that any false
information may result in denial of this application. I understand that if my application is not approved, it is not for reasons of personal bias. I
understand that once this application has been turned in, the answers I have provided may not be changed. This application will be the sole property
of the SFAHS.
______________________________________________ ________________
Signature
Date
Animal History Information: List current pets and any within the past 5 years
Name of Pet ___________________
CURRENT I PREVIOUS
Type of Pet____________________
SPAYED/NEUTERED? YES I NO
INDOORS I OUTDOORS I BOTH
Rabies Vaccine Date____________
Vet Visit This Year? YES I NO
Name of Pet ___________________
CURRENT I PREVIOUS
Type of Pet____________________
SPAYED/NEUTERED? YES I NO
INDOORS I OUTDOORS I BOTH
Rabies Vaccine Date____________
Vet Visit This Year? YES I NO
Name of Pet ___________________
CURRENT I PREVIOUS
Type of Pet____________________
SPAYED/NEUTERED? YES I NO
INDOORS I OUTDOORS I BOTH
Rabies Vaccine Date____________
Vet Visit This Year? YES I NO
Name of Pet ___________________
CURRENT I PREVIOUS
Type of Pet____________________
SPAYED/NEUTERED? YES I NO
INDOORS I OUTDOORS I BOTH
Rabies Vaccine Date____________
Vet Visit This Year? YES I NO
Name of Pet ___________________
CURRENT I PREVIOUS
Type of Pet____________________
SPAYED/NEUTERED? YES I NO
INDOORS I OUTDOORS I BOTH
Rabies Vaccine Date____________
Vet Visit This Year? YES I NO
# ______________
BREED __________
MALE OR FEMALE
NAME___________
Do you currently have a vet? YES / NO Name of Vet ___________________________________________________
How did you hear about us? Radio Newspaper TV Social Media Online Friend Billboard
I’m interested in a... DOG / CAT / UNSURE Pet Applying For (if known) __________________________
FOR OFFICE USE ONLY
Drivers License #______________________________ Birthdate_____________ Staff Signature _________________________________ Date__________
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signature
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Ad
option Policy during COVID-19 Pandemic
Due to special circumstances, adopters will not be able to meet cats, kittens, small animals, and dogs
under 6 months of age prior to adoption. If you are wanting to meet the animal before adopting, we
would highly recommend waiting until we reopen to the public. All policies are subject to change
depending on current conditions.
I understand that the Sioux Falls Area Humane Society cannot guarantee the temperament, personality,
or behavior of an animal.
I understand that if the pet does not work out in my home, I will return the pet to the night receiving
area located at the Sioux Falls Area Humane Society. I understand I will not receive a refund should I
need to return my pet.
I understand that by submitting my application it does not guarantee the pet that I am interested in will
be held for me. I understand appointments are limited each week and are scheduled on a first come first
serve basis depending on the status of the application.
I understand that to minimize staff contact and to safely practice social distancing, I must have a cell
phone and credit card to complete an adoption during my appointment.
I understand that if I miss my scheduled appointment, the animal will not be held for me and I will need
to start over in the scheduling process.
I understand that I will not be able meet multiple animals during my appointment and that I must have a
specific animal in mind to adopt prior to scheduling an appointment.
I understand that the health and safety of the Sioux Falls Area Humane Society staff is a priority as it is
essential that they are able to come to work and care for the animals. I will forfeit my appointment and
not come to the Sioux Falls Area Humane Society should I have been sick within the last month, have
COVID-19 symptoms such as fever, cough, or shortness of breath, or other similar cold or flu-like
symptoms, have received a positive COVID-19 test am awaiting results of such test, or have been in
direct contact with a person that has tested positive for COVID-19, or have traveled outside of South
Dakota in the last month. I understand that staff may have other questions that may be asked of me in
my interview for adoption.
By signing, I am agreeing to all the above statements and policies.
________
___________________________________ ___________________________________
Signature Date
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signature
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