Oregon Humane Society
ADOPTION APPLICATION 		Close this window and return to the OHS Web site
Print and completely fill out this application. Bring it when you come to the shelter.
 
Name
  		Home phone Work phone
Occupation
  		Cell phone Email
Address
  		City State Zip
How long have you lived at your current address?
  		Do you:     Own?     Rent?    Live with relatives?
(circle one)
Landlord's name
  		Phone number Do you plan to move soon?
How many children live in the household?
  		Your date of birth
How many adults live in the household?
  		Ages of children who will frequently come in contact with the adopted pet
 
How much money do you expect to spend on this pet each year?
       $50 - $100        $100 - $200        $300 - $400        $400 - $500        $600+		 Who are you adopting this pet for?
  Yourself     Relative     Friend     Pet     Other
Please list the pets you currently own.
Type of animal Sex Spayed or
neutered 		Age Kept indoors
or outdoors 		Current on yearly vaccinations
  M   F Yes   No   In   Out   Both Yes   No
  M   F Yes   No   In   Out   Both Yes   No
  M   F Yes   No   In   Out   Both Yes   No
  M   F Yes   No   In   Out   Both Yes   No
Veterinarian
Please list the types and breeds of pets you have owned in the last ten years.
Type of animal Age How long? What happened to him/her?
       
       
       
How will you confine your new pet to your property?     Fence     Dog Run     Trolley     Stake in Ground     Other
This pet will be:        Indoors only        In/Out        Outdoors only        Don't know yet
Where will the pet be kept during the day?                                                         Where will the pet be kept at night?
 

I certify that the above information is true. I also understand that giving false information on this application is grounds for denying my application. This application remains the property of the Oregon Humane Society.

Applicant's Signature_____________________________________ Drivers license/ID #_______________________
 
 
FOR OFFICE USE ONLY
Animal name
  		Kennel number Animal code number
1st Adoption counselor name
  		2nd Adoption counselor name
Confirmation Done Need Comments
 
Address verification		      
 
Identification		      
 
Tax assessor 		  Not Needed          Needed  
 
Veterinarian 		  Not Needed          Needed  
 
Pre-alter 		  Needed         Client's choice  
 
Premise 		  Not Needed    Bypass    Needed  
 
Landlord approval 		     
 
Household members(s) to meet 		  Who  
 
Pet meet 		     
SIDPROY                                                                                     Notes