Adoption Application

Adoption Application
Congratulations on your decision to adopt an animal companion for your family. The Adams County Humane Society is happy you are considering adoption from our shelter. The goal of the ACHS is to find permanent, loving, forever homes for the animals in our facility. Our goal is to match the best animal for your lifestyle and family.

In order to be considered for adoption, you must:
* Be 18 years of age.
* Current pets must be up to date on rabies and distemper vaccinations.
* ACHS welcomes adopters who rent or live in an apartment or condo! We want to alert you that some landlords and management companies have size and breed restrictions, limits on the number of pets, and/or require pet deposits or additional fees.

* Indicates required field

Date of application *

Please write name of animal you are interested in. *

Your Name *

First

Last

Your Date of Birth *

Significant Other *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Best way to be reached by phone? *

Cell Home Work

Cell Phone Number *

Home Number *

Email *

Work Number *

Best time of day to be reached? *

Morning Afternoon Evening

Emergency Contact (Cannot be yourself): *

First

Last

Emergency Contact Phone Number *

Please tell us about the members of the new pet's household (e.g # of adults/seniors/children): *

Tell us about your pets at home (check all that apply): *

I have one or more dog(s) I have one or more cat(s) I have one or more small animal(s) I'd like help with introducing a new pet to pet(s) at home

Please read and check that you understand the following: *

ACHS has the right to accept or deny this application for any reason. We choose the home we feel is the best home for the animal based on the application and the interaction with the family. If there is another dog in the household and you are wanting to adopt a dog we will have to test the ACHS dog and your dog to make sure they get along. A filled out application does not guarantee your application is approved. I hereby state that information provided is true to the best of my knowledge. Falsifying information will result in a denial of my application. I also sign that I understand how the adoption process works and the fees involved with adoption. I understand that ACHS does not guarantee the temperament, age, breed or health of any animal and agree to hold ACHS harmless for any damages the animal may do to any person or property.

By typing in your name below means you have read and agree with the above. *

Submit