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Humane Society of Wilkes Foster Adoption Application

$110 Adoption Fee for Dogs $80 Adoption Fee for Cats

Please fill in as much of the following information as you will share with us. To complete on the computer, just select the lines with your cursor and replace them with the info you type in. On other responses, you can highlight your answers in color or just select and underline. Save your responses as a Word Document or in Rich Text and add your last name to the file name. Application for (name and/or type of foster pet)

Your Name: Preferred Phone Number : E-Mail Address: City: _________________________________________________ State & Zip 1. Who will be responsible for the care of this pet? self If other, please specify name, age, and relationship of this person to you: 2. If adopted, will this pet live with you? yes

If you selected No or Shared, please explain: 3. Do you live in a . . . House

Do you rent or own your home? own If renting, do you have landlords permission to keep a pet? Yes Landlords Name:

Landlords Phone: 4. Please describe where and how this pet would be kept most of the time:

5. Is any part of your yard fenced in? Yes Please describe: 6. How long would the pet typically be alone on most days? 7. How many adults are in the household?

8. How many children are in the household? 9. Do all household members want to adopt this pet?

What are their ages? Yes

10. Please describe current and past pets (continue on back or attach page if needed):
Pet Name Cat or Dog Breed Age Sex Current on Vaccines? Spayed or Neutered? What Happened to Past Pets?

cat cat cat

cat cat cat

male yes male yes male yes male yes male yes male yes

yes yes yes yes yes yes

yes

11. Are you willing to let a HSOW member (or designee) visit your home? 12. Please supply the name and phone number for your current or most recent veterinarian:

My signature certifies that the above information is true to the best of my knowledge, that I am interested in this pet solely as a companion animal, and that the HSOW has my permission to contact my veterinarian. (Signature)

(Date)

Please feel free to write anything else that you would like us to know about you as a pet owner and/or about your plans for caring for this pet.

The members of the foster/adoption committee of the Humane Society of

Wilkes appreciate your interest in this pet. You are under no obligation to take the pet if your application is approved. We will do our best to select the most appropriate homes for the pet and to keep in touch with you during the process. We are volunteers with full time jobs and families, though, so please be patient with us. We simply want to do everything we can to ensure that no foster pet we adopt out is ever abandoned, neglected, abused or bred. We appreciate your understanding as we attempt to identify the best possible home for this pet. Part of the adoption fee goes to the Wilkes County Animal Shelter, which pays for the first vaccines, rabies shot, worming and spay/neuter of each pet at a local vet. Fifteen dollars go to the Humane Society of Wilkes to defray medical and other expenses such as heart worm test, heart worm preventative, feline leukemia test and vaccine, flea and tick treatments, antibiotics, food, and other costs. If you adopt, you will receive a record of the treatments your pet has received, which often total far more than the $15 donation we require. If you are not selected as a home for this pet, please consider adopting a pet from the Wilkes County Animal Shelter. Available shelter dogs and cats can be viewed at the shelter on Call St., Wilkesboro, NC, or seen on the web at www.humanesocietyofwilkes.org Thank you very much. Please return the application form via email (Word Doc or Rich Text Format) to

Soonerr1@charter.net

or mail to

Mary Parsons 264 Mille Run Street North Wilkesboro, NC 28659

Revised 3//07

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