Adoption Application Please enable JavaScript in your browser to complete this form.Animals NameSpeciesDogCatBreedWe ask for your patience and cooperation in this joyous process of bringing people and animals together. In order to insure the proper placement of any animal, we reserve the right to inspect the home site in which the animal will be residing.Name *FirstLastAge18-2425-4445-5455-6465+Physical AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeMailing Address (if different than physical)Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDrivers LicensePlace of EmploymentHome PhoneWork PhoneEmail *Type of HousingHouseApartmentMobileDo you?RentOwnHow Long?If renting, Name of Landlord & Phone NumberMoving in the next 6 months?YesNoHave you ever brought your pet to a shelter?YesNoDo you have a fenced yard?YesNoHow many hours a day will the pet be left alone?Where will the pet be during the day (select all that apply)KennelHouseYardPatioGarageChained outWhere will the pet be during the Night (select all that apply)KennelHouseYardPatioGarageChained outIf you want to keep your pet outside at night, describe outside shelter you will provide:Any Children in the home?YesNoIf so, what ages?Who will be responsible for the pet?AdultChildIf child, what is their age?Reason for wanting the pet?Watch DogCompanionMouserPetGiftOtherIf gift, for whom?If other, please explainWhat other pets do you have in your home?Are your pets sterilized?YesNoHow long have you owned your pets?Veterinarians Name and Phone numberEver adopted from Sierra County Humane Society?YesNoIf so, when and what?For Cat Applicants: Our cats and kittens must be adopted into Indoor-Only HomesReferences - Name/Phone/Email of two references not related to youReference 1Reference 2Please note all applications require a background check, reference check, and if applicable landlord approval and home visit.By signing this application, I attest that the information I have provided is true and I understand that giving false information will result in my application being denied. The Desert Haven Animal Refuge and Sierra County Humane Society reserves the right to deny the adoption of any pet to anyone that the Desert Haven Animal Refuge and Sierra County Humane Society feels will not provide a loving and responsible home for that animal. I understand that this application is the property of the Sierra County Humane Society and I authorize investigation of all statements in this application, references, landlord approval and background check. Any animal that is adopted can be brought back within 14 days. Within that first 14 days, an adopter returning a pet will be refunded the adoption fee less $20. I certify that all the information in this application is true and I understand that any false information may void it.SignatureClear SignatureDateSubmit
