Printable Adoption Form

Welcome to The Columbia-Greene Humane Society

Columbia-Greene Humane Society

125 Humane-Society Road

Hudson, NY 12534 (518) 828-6044

Printable Adoption Form

A printable adoption form for you to fill out for the animal you would like to call your own.

Animal's Name(s):______________________ Animal's#(s)_____________ Date:______________ ________________________________________________________________________________________

Name & Address of adopter(s):___________________________________________________________

________________________________________________________________________________________ ________________________________________________________________________________________

Name of road if different from mailing address: ________________________________________

Home Phone:________________________________ Work Phone:_________________________________

Are You 21 years of age or older? ______ Yes ______No

Does anyone in the home have allergies to animals? _____________________________________

How many people live in the household?____________ Children's Ages:_____________________ Indicate the type of area you live in:____City _____Town _____Country/farm Please indicate which of the following best describes your home:

_____house _____mobile home _____apartment

If you live in a mobile home, is it privately owned property? _____Yes _____No

Please indicate if you RENT or OWN your residence (please circle one)

If you rent, please state your landlord's name and phone

number:_________________________________________________________________________________ ________________________________________________________________________________________ Section 1: HISTORY OF YOUR PET(S) 1. What pets have you owned in the past five years?

Type of Animal & Breed

Animal's Name

Animal's Age

Was animal

spayed/neutered?

Do you still own Animal?

2. If you no longer have any of the above pets, please explain what happened to them:

________________________________________________________________________________________

3. Have you previously adopted an animal from a shelter? _____Yes _____No

Have you ever brought an animal to a shelter? _____Yes _____No 4. Veterinary Information

(a) Please state the name of your veterinarian:

________________________________________________

(b) When was your last visit to the

vet?_______________________________________________________

visit?_______________________________________________________

(d) May we use your vet as a reference? _____Yes _____No (e) Are your pets listed under your name? _____Yes _____No, If not, whose name are the records in?______________________________________________________________________________

Section 2: FOR CAT ADOPTION

1. Cat will be: _____indoor only _____outdoor _____combination

2. Do you plan to declaw? _____Yes _____No

Section 3: FOR DOG ADOPTION

1. Do you have a fenced yard? _____Yes _____No

2. Where will the dog be kept during the day? ____________________At night?_____________

3. Dog will be alone for _____hours each day (average)

4. Would you be interested in attending dog training classes? _____Yes _____No

PERSONAL REFERENCES

Please give us 2 references

Name/Relationship

Phone #