The application below is for out-of area adopters. If you live in the Seymour area, please come out and visit us and meet the dog 'in person' before applying.
If you are outside of the Seymour area and are interested in adopting a dog from us, the application can be found below. Only fill this out if you are seriously considering adding a specific dog to your family. COPY the text (from 'Pet Owner's Profile' to wher you sign/date it) and paste it into an e-mail where it can be filled out. If you need help with copying and pasting, please click here. When you have it filled out, please send it to seymourpets@frontier.com (subject line "Application - dog's name").
Please follow these directions when applying for one of our canines:
Do NOT send attachments. Because of the risk of viruses and other computer problems, attachments will not be opened!
Fill out the application completely. Incomplete applications will not be processed. All of the text from 'Pet Owner's Profile' to where you sign and date it must be in the email.
Initial the first six items stating that you understand them.
Sign and date the application.
Pet Owner’s Profile
We sincerely hope we can be of service to you. We ask that you fill out your application completely. The application is designed to help us determine if the adoption is in the animal’s best interest, and to assist the potential adopter in finding an animal most compatible with his or her lifestyle. We hope you will agree that the animal’s welfare must be out foremost consideration.
All information contained in this application will remain confidential and the property of HSJC.
In order to be considered as an adopter today, you must meet the following requirements. Please INITIAL each showing that you understand:
1) Be at least 21 years of age:
2) Have the knowledge and consent of all adults living in your house:
3) Have verifiable identification:
4) Understand that HSJC has the right to deny or accept your application:
5) Understand that adoptions are now cash only:
6) Realize, that although we will give your Pet Owner’s Profile full consideration, we do not adopt on a first come, first served basis. The animal will go to the family that can provide the best home:
***What is the name of the animal you are applying for?
If approved, when is the earliest day you will be able to come pick up him/her?
***Please only apply a few days before, as other people may also be interested***
Name:
Spouse or roommate’s name:
Address:
City, State, Zip:
How Long at this address?
Area Code/Home Phone:
Employer’s Name:
Area Code/Work Phone:
If applicable, Landlord’s name/phone number:
What types of pets have you had in the past and present?
Pet #1
Name:
Type of animal/breed:
Age and sex:
Was he/she neutered or spayed?
Where was this pet kept?
Do you still own this pet?
If you no longer have this pet, please explain what happened to it:
Pet #2
Name:
Type of animal/breed:
Age and sex:
Was he/she neutered or spayed?
Where was this pet kept?
Do you still own this pet?
If you no longer have this pet, please explain what happened to it:
Pet #3
Name:
Type of animal/breed:
Age and sex:
Was he/she neutered or spayed?
Where was this pet kept?
Do you still own this pet?
If you no longer have this pet, please explain what happened to it:
Any additional pets:
Names:
Types of animal/breed:
Ages and sexes:
Were they neutered or spayed?
Where were these pets kept?
Do you still own these pets?
If you no longer have these pets, please explain what happened to them:
Have you applied to adopt or adopted from HSJC before?
Please tell us how you heard of our organization:
If you have a pet now, who is your pet’s veterinarian?
What name is the record under?
What vaccinations has your pet(s) had in the past year?
When was your pet’s last visit to a veterinarian?
If you move in the future, what will you do with your pet(s)?
Who will care for your pets should you go away on vacation?
Do you travel frequently?
If so, who will care for your pet(s) while you are away?
How much do you anticipate spending yearly to feed, vaccinate, license and provide medical care for your pet?
Do you plan to spay or neuter your pet?
Please explain why or why not:
Does any member of your household have allergies to animals?
If so, how severe is the allergy?
About how many hours a day will this pet be without human companionship?
How many adults are in your household?
How many children and how old are they?
Which member of your household will hold primary responsibility for your pet for:
Feeding:
Training:
General Care:
Please tell us about your living situation:
You live in a: (house, apartment etc.):
You live with: (parents, friends, other, etc.):
Do you rent or own?
Please tell us why you would like to adopt an animal for us: (companion, to breed, etc.):
Have you ever brought an animal into a shelter?
If so, for what reason?
Are you familiar with the pet responsibility laws in your municipality?
What times would be convenient for a representative of HSJC to come to your home to check on the animal’s well-being?
It may take your pet up to a month or longer to adjust to its new home, especially if there are other pets involved. Are you prepared to allow it this much time?
Please provide two non-related references, providing us with phone numbers where they can be reached during the hours of 9am to 5pm:
Reference #1
Name:
Area code/Phone number:
Reference #2
Name:
Area code/Phone number:
Please provide a veterinary reference. Depending on the clinic, you may have to call their office to release your pet’s record.
Name of vet:
Area code/Phone number:
Do you have a fenced yard?
If so, please describe that fence:
Where will you exercise your dog?
Will you use a leash to exercise your dog?
Are you familiar with the needs of the breed that you have chosen?
If adopting an adult dog, how many times a day will you exercise your dog and for how long each time?
If adopting a puppy, how do you plan to housebreak?
How do you plan to prevent/deal with behavior problems such as:
Aggressive behavior:
Barking:
Housebreaking:
Chewing:
Digging:
Do you plan to take your dog to training classes?
If so, what type?
Where will your dog be kept:
During the day:
During the night:
When left alone:
What type of identification do you plan to place on your dog?
What type of food do you intend to feed your dog and how often?
Dogs often live more that 15 years. Are you ready to take responsibility for the pet’s entire life?
If there is any other pertinent information that you think we should know when considering your application, please tell us here:
By signing (typing my name) below, I certify that the information I have given is true and that I recognize that any misrepresentation of facts may result in my losing the privilege of adopting a pet. I understand that the HSJC has the right to deny my request to adopt an animal and I authorize investigation of all statements in this application. APPLICATION IS NOT COMPLETE IF NOT SIGNED.
Signature:
Date: