The Humane Society Of New York Adoption Application Page 2
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8. Do you have other animals at this time? YES
NO
If YES, how many? ______________ What kind? __________________________________________
How long have you had this animal(s)? ___________________________________________________
Is this animal(s) spayed or neutered? YES
NO
9. Have you ever had a pet before? YES
NO
If YES, how long did you have that animal? ____________________
Was that animal(s) spayed or neutered? YES
NO
What happened to that animal(s)? (Explain below)
__________________________________________________________________________________________________________
10. Have you ever adopted from the Humane Society of New York before? YES
NO
If YES, where is that animal now? ___________________________________________________________________________
11. Do you or any members of your family have allergies to animals? YES
NO
12. Are there children in your home? YES
NO
If YES, what are their ages? ________________
13. Do you travel for business or vacation? YES
NO
If YES, who will provide for you animal(s)
while you are away? ______________________________________________________________________________________
14. If you share a dwelling, are other members of the household in agreement concerning the adoption of
an animal? YES
NO
15. What is your Veterinarian’s NAME, ADDRESS, TELEPHONE NUMBER?
NAME: ___________________________________________________________________________
ADDRESS: _______________________________________________________________________
TELEPHONE NUMBER: (__________)_________________________________________________
16. Have you considered the daily expenses for maintaining an animal? (Medical, food, grooming, etc.)
YES
NO
17. Are you familiar with humane procedures for housebreaking? YES
NO
18. If a behavior problem arises, are you prepared to invest the time and expense for professional training?
YES
NO
19. Do you have screens on your windows? YES
NO
20. How did you hear about the Humane Society of New York? __________________________________________________
21. Identification (with present address) - can be supplied with your personal interview
A. ______________________________________
B.____________________________________
ADOPTION FEE IS NON-REFUNDABLE – It is a tax-deductible donation
_______________________________________
_______________________________________
Signature of Applicant
HSNY Representative
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