Date
MM
DD
YYYY
Animal Interested in Adopting:
Name of Potential Adopter:
First Name
Last Name
Phone Number
Email
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
1. Have you ever adopted from the RCHS before?
If yes, what pet(s) did you adopt and when?
2. Have you ever adopted from another Humane Society before?
If yes, what Humane Society? What pet(s) did you adopt and when?
3. Do you own a pet(s) now?
Age(s)/Breed(s):
4. Are your pets spayed/neutered?
5. If you do not currently have pet(s), have you had pet(s) in the past?
If so, what happened to it/them?
6. Have you ever had to rehome a pet?
If yes, please explain:
7. Name of current/past Veterinarian:
8. Number of adults and children in home (please list children’s ages):
9. Is an adult home during the day? Please include the name.
10. The Redwood Coast Humane Society will need approval from a landlord, rental agency, or homeowner prior to completing this adoption. Do you live in a:
11. Do you own or rent?
Time at current address?
If you are renting, do you have landlord’s permission to adopt a pet?
Please include the contact information fro your Landlord/Management Agency’s Name/Phone #, Mobile Home Park Manager/HOA:
12. Have all of the adults in the household agreed to adopt a pet?
13. Is anyone in your home allergic to cats/dogs?
14. Helping an animal adjust to a new home environment is a major undertaking. Kittens and Puppies in particular. Please describe how much time will be spent and what activities you will be doing to help this pet adjust to your home and lifestyle:
15. What behavior do you consider unacceptable in a pet?
16. How would you address an unacceptable behavior?
17. Where will the dog be when you are not home?
18. Hours per day the dog would be left alone?
19. What outside space is available to the dog?
20. Is your yard securely fenced/enclosed?
21. Do you agree that the dog will not be tied/chained outside or on a deck?
22. When the dog is outside do you agree to provide shelter from the elements?
23. Where will the dog be kept while you are at home?
25. Are you willing and able to provide care for this dog’s natural life (usually 10 – 15 years)? For example, provide daily food, routine veterinary care, vaccinations, needed medical care, supplies, etc.?
26. Will you agree to spay/neuter this dog?
27. Will you be able to keep this dog indoors and only walked on a leash when outside during the recovery time of the spay/neuter?
28. If you find yourself in a temporary situation where you must leave town or are otherwise unable to take care of this dog, who would care for it?
29. Should your circumstances change could you make arrangements for the care of this dog? For example, put a provision in your Will? Or make suitable arrangements if you need to move?
30. If for any reason you determine you cannot keep this dog, will you agree to contact RCHS before attempting to rehome the dog?
31. May a Redwood Coast Humane Society volunteer visit your home to see how and where this dog would be living?
32. Are you planning on giving this dog as a gift to someone else?
