Preliminary Adoption Application

How did you learn about the Atlanta Humane Society?

Friend
Website
Television
Event
Advertisement
Newspaper
Yellow Pages
Other

Did you see an animal on television? Yes No If so, what channel?

1. How long have you lived at this address? Years Months Own Rent

House
Apartment
Townhouse
Mobile
Other

2. Have you adopted from AHS before: Yes No

If yes, do you still have your adopted pets? Yes No

If no, please explain:

3. Are there children at home? Yes No Age(s):

4. Are you looking for a pet for yourself or for someone else?

5. Are you looking for a pet for indoors/outdoors?

6. Are you looking for:

Companionship
Security
Gift
Other:

7. Do you have a fenced yard?: Yes How high? or No

8. Do you currently have any pets? Yes No

a. If yes, what kind and how many?
b. Are your current pet(s) inside outside or both
c. Is your pet(s) spayed/neutered? Yes No
d. Up to date on vaccinations? Yes No
e. Name of Veterinarian: Phone Number:

9. Do you or anyone in your household have allergies towards animals? Yes No

10. Are you planning on moving in the near future? Yes No

If yes, when?

Please accept the terms of the following:

I understand this pet may NOT be housebroken, or obedience/leash trained and no representations are made about temperament.

I have full knowledge that no animal will be adopted to a person who misleads or fails to provide accurate information on the Adoption Application or the Adoption contract.

Signature: Date: