Pets Name: ______________________

Adoption Application Form

All adoptions are made at the discretion of The Humane Society of Tulsa.
All questions must be answered completely. Please print all information.

Name: ______________________________ Date: __________ Time: __________

Address: ___________________________________________________________
City: _______________________ State: ___________

ZIP: ________________

Email Address (required for pet health insurance): _________________________________

Daytime Phone: _____________________ Evening Phone: ___________________
Do you currently work full time or part time? ________________________________
Current Employer: ___________________________ Phone: __________________
Are you over 21 years of age?

Yes

Have you ever owned a pet before?

Do you currently own any pets?

No
Yes

Yes

Do you have a regular veterinarian?

No
No

Yes

No

If yes, vets name: _____________________________ Phone: _________________

Do you have any children who currently live with you?

Yes

No

If yes, their ages: _____________________________________________________

What is your current residence?
Do you:

Rent

Own

House

Apartment/Condo

Live with parents

Other

Live with roommate

Landlord/Parents name: ___________________________ Phone: ______________

Why do you want this animal?
Family pet
Protection (Explain: _____________________)
For children
Guard dog (At home or business? __________)
Companion
Companion for other pets
Gift - Who is the gift for? _______________________________________

How long have you been looking for a pet? _________________________________

Why did you select this particular animal? __________________________________
How will you introduce this new animal to existing pets at home? ________________
____________________________________________________________________
CONTINUED ON NEXT PAGE

If the animal does something wrong, how do you plan to discipline it? _____________
____________________________________________________________________
Where will you keep the pet when you are home?_____________________________
Where will you keep the pet when you are not at home? ________________________
Under what circumstances would you not keep this animal?
____________________________________________________________________
In the last year, have you had any pets pass away due to illness?

Yes

No

If yes, what was the type of illness: ________________________________________

Please list pets you have owned in the last 5 years:
Spayed/
Where was
Time
Type/Breed Sex
Neutered?
it kept?
Owned
_________
_________
_________
_________

____
____
____
____

_______
_______
_______
_______

_________
_________
_________
_________

What happened
to it?

_______
_______
_______
_______

________________
________________
________________
________________

FOR DOG ADOPTIONS ONLY:

Do you have a fenced yard?

Yes

No

If yes, what type and height of fence: ______________________________

FOR CAT ADOPTIONS ONLY:
Do you plan to let the cat go outside?
Do you plan to have the cat de-clawed?

Yes
Yes

Signature: ___________________________________

No
No
Date: __________________

My signature certifies that all of the above information is true, and authorizes The Humane
Society of Tulsa to verify the above information. All adoptions are subject to a home visit by HST.