Thank you for choosing to adopt from the Kitsap Humane Society! To ensure that KHS animals and adopters
are properly matched, we ask that you complete our adoption application before proceeding to a meet and
greet. Animals at KHS are homeless and for that reason, extra care is taken to place them in the best
environments possible. In some cases, an adoption may not be approved based on best interest of the
human or pet. (Please note we do not sell information to third parties. This data is strictly for adoption followups unless otherwise stated).
Last Name:_______________________________________ First Name:______________________________ Date:___________
Gender: M / F Date of Birth: ______/______/____________ Spouse/Partner Name:_____________________________________
Home Address: (Street): ________________________________________________________________________Apt.#___________
(City): ____________________________________________________________ (State):_________ (Zip): ___________________
Mailing Address, if different: ____________________________________________________________________________________
Home Phone: (________) ____________________________
Cell Phone: (__________) _______________________________
Email Address: ______________________________________________________________________________________________
Alternate contact (for microchip) Name:________________________________ Phone: (_______) __________________________
Now please tell us about your current living environment as it applies to a new animal family member.
Do you: Rent / Own / Live with relative
How long at this address?________________
I plan to move in __________ months.
If you RENT, have you checked with your landlord about pet restrictions? Yes / No Do you know if this animal is permitted? Yes / No
Number of adults in home?_____
Are there elderly people in the home? Yes / No
Number of children in home? ___________ Ages? _________________________________________________________________
Number of visiting children in home?_______________ Ages? ______________________________________________________
Have you adopted from KHS before? _________ Dog or Cat? _____________________ When (approx..)? __________________
Have you ever surrendered an animal before? Yes / No
Reason: __________________________________________________
Please tell us about your current and past pets:
Dog / Cat
M / F?
Spayed or
How long
Do you
still own?
Are you prepared to adopt an animal today? Yes / No
If no, why?
Will your pet live primarily: Indoors / Outdoors
How many hours a day will the pet(s) be left alone? ____________________ _______________________
Where will the pet(s) be housed during this time? _____________________________________________ _
What would cause you to return or rehome this animal? _________________________________________
How much do you expect to spend yearly on this pet(food, boarding, medical care, toys, training, etc)?
(circle one) $100 $500 $1000 More
6. My household is: □ active & noisy OR □ mostly quiet & calm
7. Are you looking for an animal that is (choose one from each pair):
a. Cuddly OR Independent
b. Couch potato OR Very active
c. Reserved OR Playful
8. For which potential problems would you like more information? (circle any that apply)
Excessive vocalizing
House soiling
Not good with children
Introducing to another pet
9. Are you familiar with this breed? Yes / No
With this age of animal? Yes / No
10. For DOGS only:
a. Do you have a yard? Yes / No
Approximate size of yard: ___________feet by ____________feet
b. Is it fenced? Yes
Type of fence: __________________________ Height of fence: ___________
No How will you keep the dog in your yard?:__________________________________
c. How much exercise will the dog get per day? Please detail: __________________________________
d. What is your strategy for addressing behavior issues?
e. Do you plan to take your dog to dog parks? ____________________________________________
11. For CATS only:
a. What are your thoughts on declawing? ________________________________________________
b. Would you like info on how pregnant women can handle kitty litter safely? Y / N
c. Are you familiar with FIV and FeLV testing for cats? Y / N
I certify that the above information is true. I understand that giving false information on this application is grounds for denying my
application. I understand that this application remains the property of Kitsap Humane Society.
Drivers License:__________________________________________
Internal Use Only:
Person ID#_______________________________
Adoption Fee _____________________________
FeLV/FIV test? Yes / No
Approved for ID# _______________Name _____________________
___ Yes, pending Meet and Greet
___ Yes, pending surgery
___ No
Counselor _____________________________________________
Meet and Greet successful? Yes No
Meds to go home? Yes No
Counselor _______ _____________________________________
Revised 12/2/13