Adoption Application

Pet Info

I'm interested in adopting: *

Name of Animal(s) this application is for: *

How did you hear about this particular pet?

Other: Where did you hear about this pet?

Personal Info

Name *

Employer *

Spouse/Partner Name

Spouse/Partner Employer

Physical Address *

City *

Zip *

Mailing Address *

City *

Zip *

Home Phone

Cell Phone *

Work Phone

How long have you lived at this address? *

Do you expect to move in the next 6 months? *

Email *

No email? Click here.

Do you hold a valid NH Drivers License or State ID? *

ID will be verified by your Adoption Counselor at time of interview.

Name of Veterinarian *

Why are you looking for a pet? *

Property Info

Do you rent, own, or live with relatives? *

Landlord's Name

Landlord's Phone

# of Adults *

Age of Adults *

# of Children *

Age of Children *

Do children visit your home? *

How often?

Ages?

Does your home have a fenced in yard? *

Type of Fence and Height

What other type of restraint is available? *

What type of shelter (e.g. from wind, sun & rain) is available for a dog?

Please list your current pets and any pets also on your property (i.e. landlord's or roommate's pets). Please also list all your pets from the last five years.

Name, Type, & Breed of Animal?

Sex?

Spayed or Neutered?

Age?

Kept Indoors or Outdoors?

Yearly vaccinations?

Licensed?

FIELDSET: Dog Preferences

Dog Preferences

Select from the list below

What behaviors would you not tolerate in a dog?

FIELDSET: Cat Preferences

Cat Preferences

Select from the list below

FIELDSET: Thank You

Thank You

Federal funding has made it possible for this facility to exist. As a requirement of receiving these funds, we ask you to complete the following information: *

This application will be considered without regard to race, color, gender, age, disability, religion, national origin, or political belief.

I certify that the above information is true. I also understand that giving false information on this survey is grounds for denying an adoption. This survey remains the property of New Hampshire Humane Society *

I accept these terms

Leave this field blank