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<br />M.H. <br /> <br />Bu.a.e Sod..,. 01 CoIa.rd <br />... G....ter Cabarn. Couat)" <br /> <br />Adoption Application <br /> <br />l~"" 1 <br />Incomplete applieations will not be considered. <br /> <br />Date <br /> <br />I <br /> <br />I <br /> <br />Name(s) . <br />Address City State_ Zip <br />Driver's License # ISsuing State _ Nearest Relati~ <br />Home Phone <--J amployer & Phoae L-.J <br />Do you n Own 0 Rent, Compl~ Name & Phone L-.J <br /> <br />What pets do you own now? List type and ages <br />Is your yard fenced? 0 Yes CJ No If yes, how high is it? <br />Do you live in CJ City 0 Rural <br />Where will the animal live during the day? [] Indoors <br />Where will the anima1 sleep at night? [] Indoors <br />Have you ever been convicted of a crime? <br />Have you ever relinquished an animal to Anima1 Control? <br />How many pets have you owned in last 10 years? <br />What became of each 1)f them: <br /> <br />[] Farm <br />[] Outdoors <br />[] . Outdoors <br /> <br />Do you have a Veterinarian? DYes CJ No, ifnot, who will you use? Phone L-.J <br />Name Address <br />Are you familiar with vaccination requirements Ind heartworm prevention? CJ Yes C No <br />Have you considered the expense of this animal, both routine md unexpected illneases? [] Yes o No <br />/'kat! n.d CfII'e/ul1)l tmd btitttllllte/tJo-"'l stili.",."" if you ."... <br />(initial bere) I undersl8llcl that iflhls animal is unaltered I am aareeillllo have thit c1cme III my expcIIN within the <br />aRt _ daYllIIId mum a copy of the ~ork to the H_e Som.;. <br />(initial here) IllIIdet'SWlcl thaI if dUs adoption Is approved that I may Dot len, lnI\Ifer 0WIlenhip, or IIllUlllto any <br />sbehAlt this anlmal wilhoulthe written coaMnl oflhe HUmlDe SoclMy. <br />(initial bere) I understand lh81lhe Humane Society mak81 no ~ Slated or implied IS to the h_. <br />lemperllllleat or biJlory ofthit 8lIimal. <br /> <br />How did you hear about the Humane Society? <br />PIaM 1180 lhis JpIce to td1 us 8Il}'lhiDJ that may be be1pfu1 to us in qallllllDg your eppIi~OIl, <br /> <br />Signature <br /> <br />- r.._lIaoiIIyUlo - <br /> <br />Adopter Int'oltn8uon (Required by County) Race <br />Anima1's Nlme <br />Rabies Tag # <br />Type Anima1 CJ Canine <br />Approx. Age Sex 0 Male <br />Adoption Counselor/Officer initials <br />SOW'Ce: 0 AdO!lt-I-PetlLoCltiOD <br /> <br />Sex <br /> <br />I <br /> <br />I <br /> <br />D.O.B. <br />HSm# <br />'Paid by crcheckt# CJ CIIb <br />I:J Feline 0 Otbcr <br />o Female Altered Sta1UI:(JNot Altered lj Spayed LI Neuttnd <br />DApproved D Daded/ReuOll(l) <br />o Foater . 0 Co. Sbalter r1 y-a . <br /> <br />G~5 <br />