The Humane Society Of New York Adoption Application

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___________________________ Pet’s name you're interested in (if applicable)
The Humane Society of New York
ADOPTION APPLICATION
(Must be completed before consideration)
th
306 East 59
Street, New York, NY 10022
Phone: (212) 752-4840 ext. 229
Fax: (212) 752-2803
To email the application: amk.hsny@verizon.net
Name: __________________________________________________________ Date: _____________
Address: ________________________________________________________ Apt: ______________
City: ________________________________________ State: ______________ ZIP: ______________
Home Telephone: (________)__________________________________________________________
Email Address [print clearly]: _________________________________________________________
Type of pet you are looking for:
DOG
PUPPY
CAT
KITTEN
Age range: As young as ___________________, but no older than______________________
Size (for dog): TOY (under 15lbs)
SMALL (15-25lbs)
MEDIUM (25-50lbs)
LARGE (50lbs and up)
Other specific requirements: (particular color, breed, long hair, short hair, temperament, etc.):
____________________________________________________________________________________________________________
PERSONAL REFERENCES: (other than someone who lives with you)
A) ___________________________________________ Home # (_____)_______________
Work # (____)_____________
B) ___________________________________________ Home # (_____)_______________
Work # (____)_____________
1. Are you employed? YES
NO
Occupation: __________________________________________________________
2. Name of Employer: ____________________________________________________________________
Address of Employer: __________________________________________________________________
City/State: ___________________________________________________ Zip: __________________
Business Telephone: ___________________________________________________________________
3. Work Hours: ___________________________
4. Are you 21 years of age or older? YES
NO
5. Who is this animal for? ________________________
?
?
6. Do you live in an apartment
or house
Do you have a yard
YES
NO
(For dog adoption
)
?
Do you have a fenced-in yard
YES
NO
If yes, describe:
7. Are animals allowed in your dwelling? YES
NO

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