Henry County Humane Society Geneseo Chapter - Adoption Application

Adoption fee is $40		Approved by ____________________________ (for office use only)

Geneseo Humane Society Application for Pet Adoption
Name:		Age:
Address:
City:		St:	Zip:
Home Phone:		Cell:
e-mail (optional):

The Geneseo Human Society's goal is to arrange adoptions which best suit both the animal and its new family. We reserve the right to refuse to place an animal in an unsafe or unsuitable environment. Please complete the following: Who resides in your home?
	Name	Age
Yourself:
Spouse/Other Adult:
Child:
Child:
Child:
Dogs:
Cats:
Other Pets:

If you have children, have they been around animals:
What happened to the former pets you had? (i.e. run over by car, heartworm, died of old age, etc)

Do you own your home?

Or do you rent?

If you rent, please provide: name of landlord and telephone no.
(We must confirm that your landlord permits pets.)

If you adopt an animal, will the pet be inside or outside?
If outside, do you have shelter (such as a dog house)?
Is your yard fenced in (Fencing is not required for all dogs)?
If you have owned a pet in the past or have one now, please indicate the name of your vet and their telephone number:
Give two personal references:

	Name		Phone Number
1)
2)
You cannot adopt an animal for someone not residing with you and we require that if---- for any reason----the adoption of an animal does not work out, you must return the animal to our Geneseo Animal Shelter. Thank you for your interest. We would love to help you find a pet!!!!

Specific Animal to adopt? If so, please specify:

Signature:

Date:

As soon as your application has been approved, we will contact you to arrange a time for you and your new best friend to get to know each other!!!!!!!!!