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Adoption Application

Humane Society of St.Clair County/S.N.A.P
Pre-Adoption Application

Welcome to the HSSCC/S.N.A.P Adoption program. The following information is requested so that we can assist you in the selection of your new pet. This form and a home visit are designed to help you find the furry friend that will be most compatible with your lifestlye.

In order to be considered as an adopter you must:

-Be at least 21 years of age.

-Have signed consent from your landlord if you are not a homeowner.

-Be willing and able to the spend the time and money necessary to provide proper training, medical treatment and proper care for your pet.

Completion of this form does NOT guarantee an adoption.

Thank you!

* Denotes required fields

Your Full Name: *
Phone Number: *
Cell Phone Number: *
Email: *
Address: *
City: *
State: *
Zip Code: *
Place of employment: *
Are you over 21 years old?: *
Date of birth: *
How many adults live in your home? Please list names.: *
How many children live in your home? Please list their ages.:
Do you rent or own your home?: *
If you rent your home, please list the name and phone number of your landlord.:
What type of home do you live in? (i.e house, condo, mobile home, apartment): *
Do you have a fenced in yard?: *
If so, what type of fence?:
If your yard is not fenced in: How do you plan on containing your pet? How will your pet get exercise and go potty?:
How long have you lived in your home?: *
How long do you plan on living in your home?: *
Where will your pet primarily stay? : *
Where will your pet stay when you are not at home?: *
Approx, how many hours a day will the animal be home alone?: *
Where will your pet sleep?: *
Please list the names of the animals that you currently have, their breed, age, as well as how long you have had them.: *
Please list the names of the animals that you have had in the past 10 years that you no longer have and the reason why.: *
Please list the name(s) and phone numbers of your veterinarian(s) you have had for the last 10 years.: *
Are all of your animals current on vaccinations?: *
Current on heartworm test & preventative?:
Are they all Spayed/Neutered?: *
If you own a dog(s), are they currently licensed with the County that you reside in?: *
If no, please explain.:
*Name of the animal that you are interested in adopting.:
Are you willing to allow home visits and phone calls to check on the animal?:
If applying for a dog, are you willing to take the dog to obedience classes if required?:
Why are you choosing to adopt a pet?:
Please list the names of 3 references that you have known for at least 5 years: name, phone number and relationship to you.:
I agree that I have answered to the best of my knowledge and understand that by electronic signature, that I am allowing HSSCC SNAP to contact references, Vets and perform a minor background check. (Type Full name and date in text box):