Adoption Application - Humane Society and Adoption Center of Rockport-Fulton

Fill out the online form or download and print an application

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Phone *

Name of the animal you are interested in adopting *

Number of Adults in the home *

Number of Children in the home *

Do you own or rent? *

Own
Rent

Type of Home *

Single Family Home
Apartment
Condominium
Mobile Home

We welcome adopters who rent, or live in an apartment or condo. We want to alert you that some landlords and or management companies have limits on size, weight, breed or number of pets, and may require a pet deposit.

Current or Past Pet #1 Name and Type

Do you still have this pet? If not what happened?

Was Pet #1 Spayed or Neutered

Yes
No

Is or Was Pet #1 Current on Vaccinations?

Yes
No

Current or Past Pet #2 Name and Type

Do you still have this pet? If not what happened?

Was Pet #2 Spayed or Neutered

Yes
No

Is or Was Pet #2 Current on Vaccinations?

Yes
No

Current or Past Pet #3 Name and Type

Do you still have this pet? If not what happened?

Was Pet #3 Spayed or Neutered

Yes
No

Is or Was Pet #3 Current on Vaccinations?

Yes
No

I give permission for the Humane Society and Adoption Center of Rockport-Fulton to request and verify records from my veterinarian.

Initials

Fence Height (in feet)

Is someone home during the day? *

Yes
No

How do you plan to exercise your pet? *

Have you had to re-home a pet previously? *

Yes
No

We are committed to positive reinforcement training, can you continue with the same approach? *

Yes
No

Do you understand that an animal’s behavior in the shelter may be different than the behaviors exhibited in the home? *

Yes
No

It may take your new pet six weeks or longer to adjust to your home, sometimes longer if other pets are involved. Are you prepared to allow this much time to adjust? *

Yes
No

Would you object to an inspection of your property by our staff? *

Yes
No

Please provide the name and phone # of the person or persons who will take responsibility for your pet in case of a major life altering event such as: household changes, illness, or death.

I understand that if I have to return my pet to HSAC, I agree that I will pay a surrender fee of at least $50.00

Initials

I understand that this is an adoption, not a sale, and the HSAC of Rockport-Fulton reserves the right to refuse or rescind any adoption. I understand that if approved, I will have 3 days to pick up the animal unless prior arrangements have been made. Signing below, I certify that the information I have given is true and that any misrepresentation of facts may result in my losing the privilege of adopting a pet.

Initials

Comment or Message *

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Date

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