The Humane Society of Southern Maryland and York Pennsylvania

Name or Description of Dog/Cat(s) Applying For:
Name:
Address:
Home Phone:
Work Phone:
Email Address:
Why do you want to adopt a dog or cat?
Have you ever owned a pet before?	Yes No
If yes, what kind of animal(s)?
Which of these pets do you still own?
Please describe any pets you currently own (type/age/sex/etc.)
Are they spayed/neutered?	Yes No
Which of these pets do you no longer own?
What Happened to It/Them?
What Do You Think are the Most Important Resposibilities in Owning a Dog/Cat?
For Whom Are You Adopting the Dog/Cat?	Yes No
Do You Have a Veterinarian in Mind?	Yes No
Please Specify
How Many People Currently Reside in Your Household?
Adults:
Children:
Ages:
Who Will Be Responsible for Feeding the Dog/Cat and Taking It Outside?
Do You Own or Rent Your Residence?	Yes No
If Rent, What is the Name of the Landlord and the Phone Number?
Are Pets Allowed?	Yes No Not Sure
Where Will the Dog/Cat Be Kept?	Indoors Only Outdoors Only Indoors and Outdoors
How Much Time Will the Dog Spend Outdoors? Do you let your cats outside?
Will There Be Anyone Home During the Day?	Yes No
How Many Hours Will the Dog/Cat Be Left Unattended?
When You are Home, Where Will the Dog/Cat Be Kept?
When No One is Home, Where Will the Dog/Cat Be Kept?
Do You Have a Fenced Yard?	Yes No
If Yes, How High is the Fence? (in feet)
What Type of Fence?
How Frequently Do You Make Business/Vacation Trips?	None 1-2 2-3 3-4 5+
Are You or Your Spouse with the Military?	Yes No
Are You Aware of the Spay/Neuter Policy?	Yes No
Are You Aware of the Adoption Fees?	Yes No
Are You Willing to Sign the Legal Pet Adoption Contract?	Yes No
Have You Reviewed the Adoption Rules? Contact us at 717-845-3797 or email to hssmdpets@aol.com for our adoption requirements/rules. We do not permit declawing of our adopted cats.	Yes No
Please list any preferences you have in adopting a dog/cat (age, sex, breed, personality, etc.):

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