Adoption Inquiry Form Thank you for your interest in adopting a pet from the HSCC. Help us find a great match for you by completing this form in its entirety. To be considered as an adopter you must:(Required) Be at least 21 years of age. Have the knowledge and consent of all adults living in your household. Live in Georgia, be a legal U.S. resident, and provide a valid ID with current address. For renters, have the consent of your landlord/property owner and be prepared to provide us with a copy of the signed Pet Agreement Addendum to your lease. Understand that the completion of this inquiry does not guarantee adoption of an HSCC animal. Name(Required) First Last Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Email(Required) Is there a specific animal(s) you have an interest in? Yes No If so, Cat? Dog? Name of specific animal(s) What are the best days and times to contact you?(Required)Do you rent or own?(Required) Rent Own If renting, when does your lease expire? MM slash DD slash YYYY Landlord’s name and phone # (if renting): Are there any pet restrictions/regulations where you currently live?(Required) Name of any previous and/or current veterinary clinic(s):Clinic phone #(s):Number of adults in the house/apartment:(Required)Please enter a number greater than or equal to 0.What is their relationship to you?(Required) Number of children in the house/apartment:(Required)Please enter a number greater than or equal to 0.What are their ages?(Required) Pets in Your HouseholdNames, Ages, & M/F of Cats in Your Household Add RemoveDeclawed? Yes No Are the Cats indoor/outdoor/both? Indoor Outdoor Both Names, Ages, & M/F of Dogs in Your Household Add RemoveAre the Dogs indoor/outdoor/both? Indoor Outdoor Both Fenced yard? Yes No If yes, privacy/chain link/electrified? Privacy Chain Linked Electrified Are Your Pets spayed/neutered? Yes No Which heartworm preventative is currently being used (if any)? Does anyone in your household suffer from allergies? Yes No If yes, please explain:Have you ever owned pets before? Yes No If yes, what type?Were all previous pets spayed/neutered? Yes No Were they indoor/outdoor/both? Indoor Outdoor Both If cats, were any declawed? Yes No For pets no longer in your care, please describe what happened to them (e.g., euthanized, passed away, sold, given away, disappeared, etc.):(Required)Have you ever adopted from the HSCC before?(Required) Yes No If yes, pet’s name and when:Why are you currently considering adopting a pet?Will this pet be a gift or surprise?(Required) Yes No Who will be the primary caregiver of your pet, to include daily care and training?(Required) Do you have a doggie door on any exterior door? Yes No How many hours will the pet be alone on a typical day?Please enter a number greater than or equal to 0.Where will your pet be kept when left alone on a typical day?(Required)Where will your pet be kept when you are away for long periods, such as vacation?(Required)In the event you become unable to be responsible or care for your pet(s), what would you do?(Required)ACKNOWLEDGMENT I am aware and acknowledge that the HSCC is a nonprofit, no-kill organization assisting in the welfare and adoption of animals, that adoptions are based on a “best match” basis not a “first-come” basis, and that the HSCC reserves the right not to adopt to anyone for any reason. I understand that some dogs require a fenced yard and, in these instances, a fence check may be conducted as part of the adoption process. I am financially able to provide for the animal and I understand that I must provide necessary food, shelter, and veterinary care, which can be costly at times. I certify that the information provided on this form is true and accurate.Signature(Required)Date of Signature(Required) MM slash DD slash YYYY Δ