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HSSC - PET ADOPTION APPLICATION
Questions marked by * are required.
1. Adoption Application For: *
2. Looking to Adopt - Pet Name: *
3. Adoptee(s) Full Name (First Name & Last Name): *
4. Home Address: *
5. City: *
6. State: *
7. Zip Code: *
8. Home # (if not applicable, type N/A): *
9. Cell # (if not applicable, type N/A): *
10. Email Address: *
11. By adopting an animal from the Humane Society of Stanislaus County (HSSC), it is understood that this is a rescue animal and therefore the complete health/behavioral history prior to our care and custody is not known. Please initial below. *
12. Regardless if this adoption application is approved or denied, this application is property of HSSC. HSSC reserves the right to refuse any adoption without explanation. Please initial below. *
13. In order to adopt from HSSC, you must: (1) Have a current identification with present CA address (2) Be at least 18 years of age (3) Have permission from your landlord or own your home (4) Upon approval of adoption application, sign an Adoption Contract (5) Complete a microchip transfer form if applicable (6) Consider purchasing pet insurance (7) Continue with appropriate vaccinations, at your own expense, after adoption. Please initial below. *
14. I live in a… *
15. If "Other" above, please explain:
16. I currently… *
17. If "Rent" above, do you have a pet deposit?
18. If “Rent” above, Landlord Name & Phone:
19. Name of other adults in household: *
20. Names of children living in household & age(s): *
21. Describe the area and street where you live (ex: quiet, busy, noisy, etc.): *
22. Would you be willing to do a home check if necessary? *
23. How long have you been looking for a new pet? *
24. Why do you want to adopt a new pet? *
25. If I move, I would do the following with my pet(s)… *
26. Have you ever lost a pet at an early age or due to an accident or illness? *
27. If “Yes” above, please let us know what happened:
28. Have you ever given up a pet? *
29. If “Yes” above, please let us know where the pet ended up (ex: family member, shelter, etc.):
30. Do you have a current vet? *
31. If “Yes” above, please let us know your Veterinarian Name & City:
32. Are you financially able and willing to provide annual checkups & vaccinations? *
33. Would you be able to provide emergency veterinary care for the new pet if needed? *
34. Will you able to make arrangements for your new pet when you travel? *
35. A cat/dog can be expected to live 15 to 20 years. Are you willing to make a lifetime commitment to this pet? *
36. If your adopted pet gets lost, what would you do? *
37. How long are you willing to allow the new pet to adjust to their new home? *
38. What will you do if your new pet does not get along with your present companion animal(s)? *
39. *** If looking to adopt a CAT… *** Do you know what declawing is?
40. *** If looking to adopt a CAT… *** Do you believe in declawing?
41. *** If looking to adopt a CAT… *** If "Yes" above, please explain your answer
42. Current Pet 1 - (1) Name, (2) Gender?, (3) Cat/Dog?, (4) Breed?, (5) Age?, (6) % Indoors?, (7) % Outdoors?, (8) Spayed/Neutered?, (9) Shots Up to Date?, (10) How long have you had this pet?
43. Current Pet 2 - (1) Name, (2) Gender?, (3) Cat/Dog?, (4) Breed?, (5) Age?, (6) % Indoors?, (7) % Outdoors?, (8) Spayed/Neutered?, (9) Shots Up to Date?, (10) How long have you had this pet?
44. Current Pet 3 - (1) Name, (2) Gender?, (3) Cat/Dog?, (4) Breed?, (5) Age?, (6) % Indoors?, (7) % Outdoors?, (8) Spayed/Neutered?, (9) Shots Up to Date?, (10) How long have you had this pet?
45. Current Pet 4 - (1) Name, (2) Gender?, (3) Cat/Dog?, (4) Breed?, (5) Age?, (6) % Indoors?, (7) % Outdoors?, (8) Spayed/Neutered?, (9) Shots Up to Date?, (10) How long have you had this pet?
46. Current Pet 5 - (1) Name, (2) Gender?, (3) Cat/Dog?, (4) Breed?, (5) Age?, (6) % Indoors?, (7) % Outdoors?, (8) Spayed/Neutered?, (9) Shots Up to Date?, (10) How long have you had this pet?
47. What percentage (%) of time will your new pet spend Indoors? *
48. What percentage (%) of time will your new pet spend Outdoors? *
49. If “Outdoors” marked above, when outside will your new pet be (check all that apply):
  • Supervised
  • Unattended sometimes
  • Unattended most of the time
  • In a dog run or catio
  • In a fenced yard
  • Have a collar w/ an ID tag on
50. Upon APPROVAL of your application, your will be enrolled in our “KEEP ME INFORMED” communications notifications. Please initial below to acknowledge you understand you will be receiving communications from HSSC. *
51. By typing my name below, I acknowledge that all information on this form is true and correct. I understand that any misrepresentation of fact may result in HSSC refusing adoption privileges to me. I authorize HSCC to contact all veterinarians listed on the application and the landlord if applicable. If my request for adoption is approved and later HSSC discovers the above information is not true or correct, HSSC reserves the right to remove the adopted pet from my home and from my care. I/We understand that if this application is approved, it will be attached to either a Cat or Dog Adoption Contract that will contain information regarding the animal being adopted and along with medical records obtained by HSSC. *
52. Do you have any questions regarding this animal?