Welcome to Sumter Humane Society
(You can copy and paste this application into an email, fill it out and email it to
Joe Hooks, our Adoption Counselor at joeshs@att.net
or print and mail to:
Sumter Humane Society
108 Industrial Blvd.
Americus, GA 31719
 

Please note that adoptions are not done on a first come, first serve basis, and filling out an application does not guarantee the adoption on any dog/cat. We reserve the right to refuse any applicant, at any time, for any reason. We are looking for the best possible home for this animal. Thank you for your cooperation and understanding.

Please also note that we WILL check your current and past animals veterinary records for a reference. We will call only the veterinarian that you put down on this application. If you have additional information about your current animal, or would like us to contact a different veterinarian for this animal, please make appropriate notations. Please also note that we WILL NOT accept an application that is not filled out in its entirety. If a question does not apply to you, please mark “NA”.

 

In order to be considered for an adoption today, you must:

1. Be 18 years of age

2. Have the knowledge and consent of all adults living in your household

3. Have a valid ID with current address

4. Have landlord’s name and telephone number (or lease)

5. Understand that Sumter Humane Society must approve your application

 

Name:__________________________________________________________________

 

Address:________________________________________________________________

 

City:_____________________________________State:____________Zip:___________

 

Home Phone:_____________________WorkPhone:____________________

 

Cell Phone: ____________________________Age:______

Email Address: ___________________________________________________________

 

Employer name/Business Name _____________________________________________

 

Length of employment ________ Phone Number: ______________________

 

1.                    What type of pet are you looking for?

DOG       CAT                       MALE      FEMALE                   ADULT    PUPPY     KITTEN

Size:________________________________

 

2.                    Do you want a particular breed? If yes, what breed?______________________­­­__

 

3.             Do you want this pet for: COMPANION         PROTECTION      BREEDING            GIFT                OTHER__________________________

 

4.              This pet will be without human companionship for about ____________ hours

per day, ______________days per week.

 

5.             Where will your pet be kept during the day? (circle all that apply)

INDOORS              OUTDOORS              DOG PEN                 CRATE                BASEMENT         GARAGE OTHER______________________

 

During the night?  INDOORS                   OUTDOORS  DOG PEN               CRATE         BASEMENT        GARAGE                   OTHER________________________

 

6.        How will your animal be walked?

                FENCED IN YARD              TIE OUT   LEASH WALKS

 

 

7.             Do you plan to let your cat outdoors?             YES        NO    

                If yes, how often?______________________                            

 

8.             Where do you live? HOUSE  APARTMENT CONDO TRAILER OTHER______

                _________I RENT              ________I OWN ________WITH MY PARENTS     

 

Landlord’s name:______________________________Phone:________________

Does your landlord allow pets?         YES         NO          DON’T KNOW

                Deposit required?____________________ 

 

9.             Do you have a fenced yard?              YES         NO

                If fenced, please describe the height and type:____________________________

 

10.                 Please provide the following information about your household:

Number of adults:________Number of children:________Ages:______________

 

11.           Is anyone in your family allergic to animals?_____________    CATS     DOGS

 

12.           What will you do with your pets if you move in the future:__________________

_________________________________________________________________

 

13.           How much do you anticipate spending yearly to feed, vaccinate, license and

      provide medical care for your pet?______________________________________

 

14.           Would you be willing to allow a representative from the shelter visit your home    

before the adoption is completed?______________________________________

 

15.           Have you adopted an animal from us before?_____________________________

 

16.           What type(s) of pets do you own or have owned in the last 10 years?

Name	Type/Breed	Kept Where	Age	Neutered	Sex	Still Own?
				YES   NO		YES   NO
				YES   NO		YES   NO
				YES   NO		YES   NO
				YES   NO		YES   NO

 

17.      Who is (was) your veterinarian for the above animals? Name:________________________________Phone:_______________________

 

18.           Do you realize that a dog or cat may live 15 or more years?         YES         NO

 

 

19.           It may take your new pet two or more weeks to adjust to its new home, especially

      if other pets are involved.  Are you prepared to allow this much time? YES   NO

 

20.           How do you plan to house train your dog?______________________________

                ________________________________________________________________

 

By signing below, I certify that the information I have given is true and that I recognize that any misrepresentation of the facts may result in my losing privilege of adopting a pet.  I authorize investigation of all statements on this application.  I understand that this application is property of the Sumter Humane Society. I also understand that no animal coming from this facility can ever be chained, tethered, or tied. Failure to comply with this will give Sumter Humane Society the right to claim my adopted animal.

 

 

Signature:_____________________________________________Date:______________