Home Adoption Adoption Application

Hanover Humane Society Adoption Application

Please Note: We are committed to finding permanent, responsible, and loving homes for our animals. We make adoption decisions based on (1) the pet’s temperament and needs as well as (2) the applicant’s experience, family, lifestyle, personal references, yard, housing situation, employment, veterinary history and additional factors.

The Hanover Humane Society reserves the right to deny adoption to anyone who, in its opinion, will not provide a suitable, safe and responsible home for the pet.

The application process takes up to 5 business days. You will not be able to take an animal home today. References will be checked, a home visit may be requested and follow-up communication may be required. To expedite the screening process, communication by email is preferred. Please complete all data fields and respond to all questions on the application. Missing information is deemed an incomplete submission and may result in a declined adoption application.

Animal of Interest: 
Type:  Dog Cat Gender:  Male Female
Contact Information
Applicant Name: 
Drivers License # : 
Physical Address:
City:  State:  Zip: 
Home Phone: 
Work Phone:  Cell Phone: 
Email Address: 
Best Time to call: 

To facilitate faster communications, we prefer email. If you provide your email address, this will be our primary means of contacting you.

Personal and Residential Information
Are you at least 18 years old?  Yes No
Note: Hanover Humane Society reserves the right to validate our minimum age requirement
Marital Status: 
If you are single: 
Do you live alone?  Yes No
If No, do you live with:  Family Roommate(s) Significant Other
Name of family members/roommates/significant other: 
If you are Married:
Spouses Name: 
Spouses work hours:  N/A
Number of adults in your home: 
Number of children (including visiting grandchildren): 
Ages of children: 
Do you work outside the home?  Yes No
If Yes, what are your hours? 
Employer: 
Occupation/Job Title: 
Does anyone run a business from your home?  Yes No
If yes, please specify: 
Do you:  Own Rent
Type of dwelling:  House Mobile Home Apartment (floor #)
Do you have a fenced yard?  Yes No
If so, describe the fence (invisible, wooden or chain link, height, etc): 
If leasing, does lease allow pets?  Yes No Don't Know
Name of leasing company or apartment complex: 
Phone: 
Lifestyle and Pet Preferences
Do you anticipate any major lifestyle changes within the next year? For example:  moving, marriage, new baby:

Please Explain:

Who will be responsible for this pet? If other, please explain: 

Who will care for your pet when you are away (overnight): 

Where will your pet be kept?

Does anyone in your residence have asthma or pet allergies?

If someone in your family is allergic, what steps will be taken to try and keep the animal in your home?

Are all residents in your home aware of and agreeable to adopting a pet?

What type of personality are you looking for in a pet? 

What interests you most about this particular animal? 

What behavior problems would be unacceptable and how would you deal with them should this pet exhibit these behaviors? 

Other Pets
Do you currently have other pets? (fill in chart)
Note: If you have had other pets within the past 5 years, please include them on the chart below (even if deceased
Pet Name Breed / Description Gender M / F Current or past pet? Dates or time owned Sterilized Y / N Current on All Shots?(Y/N) Pet Lives in, out, or both
Are all dogs listed above current on heartworm testing and preventive?

Have all cats listed above been tested for feline AIDS/ feline leukemia?

Are there other pets living in your home that are not yours?  (If yes, add them to the form above)

Have you had a pet or pets in the past?  (specify)

What happend to the pet(s)?

Do you have a regular veterinarian? 

Name of Veterinarian or Vet Hospital: 

Address:  Phone:

Do any of the animals listed on the chart above have records at a different veterinary facility? 

Name of Veterinarian or Vet Hospital: 

Address:  Phone:

Have you ever adopted from any rescue organization, shelter or humane society? 

If yes, please list which one:  Where is the pet now?

Have you ever turned in any animals to an animal shelter, humane society or rescue organization? 

If so, what was the reason?

Have you or anyone in your family or household ever been charged with animal cruelty, failure to provide adequate veterinary care, or animal neglect?     If yes, please explain: 

Miscellaneous information and Signatures

List two personal references below with their phone number. Select friends, colleagues, neighbors, clergy, etc. (not family)
1. Phone: 
2. Phone: 

How did you hear about the Hanover Humane Society and/or this animal? 

How much money are you expecting and willing to spend annually on pet expenses and veterinary care? 

PLEASE READ BEFORE SIGNING:

I confirm that all information on this application is complete and correct to the best of my knowledge. I authorize verification of all information with veterinarians, personal references, landlords and other sources as applicable. I recognize that veterinary history will be checked to determine an overall pattern of care and pet maintenance. I understand that all adoption decisions are made by an adoptions committee with oversight by the HHS Board of Directors. I understand that all adoption decisions are considered final and not subject to appeal. In addition, I understand that, to protect the integrity of the screening process and to assure truthful responses on applications from other parties, the reasons for declining my application, should that occur, will not be disclosed to me by the Hanover Humane Society.

By checking this box I attest that I have read this application in its entirety and fully agree to the terms of the Hanover Humane Society application process.

Name of Prospective Adopter: Date:

Please enter the code on the right:

  

Note: please ensure the code is correct. If the code is not entered correctly you will have to start over.

Hanover Humane Society, 12190 Washington Highway Ashland, VA 23005 Phone 804.798.0806
E-mail: info@hanoverhumanesociety.org