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Henrico Humane Society is committed to finding permanent, responsible and loving homes for the animals in our care. Henrico Humane Society does not have a shelter; all of our animals are kept in temporary foster homes until permanent, loving homes can be found for them. Adoption stands are held on Saturdays at various locations. Henrico Humane Society adopted more than 500 dogs and cats in 2009!

Adoption Application

We are committed to finding permanent responsible, and loving homes for our animals.

 

Thank you for your interest in adopting a homeless animal. Please complete all fields on this application and print it before clicking “Send Application”. An adoption counselor will get in touch with you after contacting the references you provided, including your previous or current veterinarian, landlord and personal references. Your patience while our dedicated volunteers process your application is greatly appreciated. 
 
Please note: an incomplete application will not be considered. A home visit will be required for some pets.
First Name:
MI:
Last Name:
Street:
City: State: Zip:
Home Phone:
Work Phone:
Cell phone:
Employer:
Email:
What is your age?  
Is there a specific animal you would like to adopt?
  Yes No
  If so, please describe the animal:
Who will be the primary caregiver of this pet? 
Who is the pet for?
  Myself    Our Family    Children   
  Gift - for whom?
Why is this a good time to adopt a pet?
Marital Status:
  Single    Married    Separated    Divorced    Widowed
  Number of adults in your home:
  Number of children and ages:
Are all adults in your home aware of and agreeable to adopting a pet?
Yes   No
Does anyone in your home have asthma or pet allergies ?
Yes   No
Do you anticipate any major lifestyle changes
(moving/marriage/new baby)?
Yes   No
If yes, please explain:
What would happen to your pet if you have to move?
Who will take care of your pet when you are away(overnight)?
Will your pet be left alone for 4 or more hours during the day(or night)?
Yes   No   # Hrs:
Where will your pet stay when it is left alone?
Have you had pet(s) before that are no longer with you?
  Yes   No  
  What kind of pet?
  How many?
  What happened to that/those pets?
Have you previously adopted a pet through a humane society or animal shelter?
  Yes   No  
  Type of Pet:
  Adoption Date:
  Name Of Shelter:
Have you ever returned or surrendered a pet through
a humane society or animal shelter?
  Yes   No  
  Type of Pet:
  Surrender Date:
  Name Of Shelter:
  Reason for Surrender: 
Have you ever been reported to animal control
or had an animal removed from your care?
  Yes   No
  If yes, when did this happen?
  Please explain the circumstances and the outcome:
Do you have other pet(s) now?
  Yes   No  
  If yes, please tell us about them:
 
 Type of  Pet  Pet's name   Age   Sex   Spayed /  Neutered Last shots (Date) How long have you had this pet ? Where does this pet stay?
(In, In/Out, Out)
Yes
No
Yes
No
Yes
No
Yes
No
What type of pet are you looking for now?
  Dog   Puppy   Cat   Kitten  
  Any particular color or breed/mixes? 
What characteristics are you looking for in a pet?
 
Playful Easygoing Companion
Good with kids Housebroken Crate-trained
Litter box trained Good with dogs Obedient
Guard dog  Lap cat Good with cats 
Energetic  Outdoor dog  Previously declawed
Likes to run   Indoor/lap dog   
  Other characteristics:
  What behaviors would you find unacceptable in your pet?
  How would you handle behavior problems in your pets?
Do you agree to have your pet spayed/neutered(if it has not been done already)?
  Yes   No 
  If not, why not ? 
Who is your current or previous veterinarian ?
 
  Phone number:
Are you able to provide monthly flea and heartworm prevention?
 Yes   No 
Do you -
  Own or Rent your home?
  If renting, give name and phone number of landlord:
  Do you have a yard? 
Yes   No  
  Is it fenced?
Yes   No  
  What type of fence?
  Fence Height:
  Does your lease allow pets?                                                                 
Yes  No   Don't Know
  Does your lease limit the number of pets living in your home?                
Yes   No   Don't Know
  Does your lease limit the size(weight) of the pets living in your home?     
Yes   No   Don't Know
  What is the size limit?
  What is the maximum number of pets allowed by your lease? 
  How long have you been living at your current residence?
years months
If less than one year, please provide your previous address:
Street:
City: State: Zip:
REFERENCES: (Please list someone outside your home):
Name Phone Number Relationship to you






* * * * * * Henrico Humane Society Pet Adoption Application * * * * * *

By signing below, I certify that all the above information is true and I recognize that any misrepresentation of facts may result in loss of my adoption privileges.

I authorize verification of all statements in this application with the listed veterinarian, references and landlord.


Henrico Humane Society reserves the right to refuse an adoption to anyone who, in its opinion, will not provide a suitable home for this pet.

_________________________________________________ ________________
To be signed in the presence of an HHS representative Date



Driver's License #: ______________________________

Interviewed by: (HHS Adoptions Counselor):

____________________________________________





For HHS Adoptions Counselor Use:

RE: HHS animal ID #: ______________________________________

Pet's Name: _____________________________________________

Interview Date: ___________________________________________

Interviewed by: ___________________________________________

Adoption Stand Location: ___________________________________

Recommendations:







Outcome:








Please print these pages BEFORE you click on the Send Application button below and bring the form (unsigned) with you when you meet with the HHS representative that contacts you about the adoption process.

  

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