Adoption Application Home » Adoption Application Basic InformationApplicant Name First Last Permanent Address* Street Address Address Line 2 City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Home PhoneCell PhoneEmail* Personal InformationWhat type of home do you live in?*Please SelectHouseCondoApartmentAcreageTrailerDo youRentOwnIf you rent, please provide a letter from you landlord with their contact informationHow many dependents are in the home?*Are there children in the home?*YesNoAre there any Pet Allergies?Please SelectYesNoEmployment InformationInclude Spouse Employment Information?*SelectYesNoOccupation*Employer*How Many Years?*How Many Hours Per WeekPartner/Spouse Employment InformationOccupation*Employer*How Many Years?*How Many Hours Per WeekPet Ownership InformationAre you financially prepared to own a pet?*SelectYesNoDo you Currently Have Any pets?*Please SelectYesNoPlease list current pets*Pet NameDescription With previosly owned pets, please explain why they are no longer in your care.Have you ever been investigated for or charge with animal cruelty?*SelectYesNoFor past and present pets, were they spayed/neutered?*SelectYesNoWhy Not?*Have you ever re-homed, or surrendered an animal?*SelectYesNoWhat was the reason?If you have to move, will the pet be going with you?*This should be considered as the pet is a family member and should be part of any life changes.SelectYesNoWhere will this pet spend the majority of their time?Please SelectIndoorsOutdoorsHow Will you contain your pet when outdoors?*Fence, Tether....etcWhy are you considering adding a pet to your family?*Please select all of the responsibilities you are willing to take on as a pet owner Spaying and neutering Vaccinations and vet checks Good nutritional diet Be kept as part of the family Prepared for any medical emergencies Provide a safe, loving and forever home for the animal Proper exercise and training References*Please provide the names, addresses, and phone numbers of 3 references (one preferably of a professional such as a veterinarian):NamePhoneAddressRelationship What kind of animal are you looking for?*Please SelectCatDogBirdRabbitReptileSmall AnimalPlease Check if you understnad You understand that all animals adopted must be fixed by the age of 6 months? You understand that the average dog ownership can cost $1300-$2000/ year and cat ownership can cost just about the same? You understand the bylaws regarding animals in your area? You understand that exercise and training is an important factor in animal behaviour? You have you researched/understood the breed which you want to adopt? You know that any animal can have an unforeseen medical issue which you will be financially responsible for? Is your entire household on board with this adoption? You understand that your newly adopted animal may need to relearn housebreaking skills?_______ If you must give up the animal your are adopting, it must be surrendered back into the care of the Humane Society. You are not to re home or adopt out the pet on your own. The staff wants to remind you that every animal is different, with their own personalities. Sometimes it can take up to two weeks before the animal is settled into their new environment and becomes comfortable in their new home. Be patient. We also do our best to learn as much about the animals prior to adoption, but certain behaviours can be unseen – do not hesitate to contact us if you have concerns or questions. All applicants are required to undergo an interview, home inspection, reference checks and criminal checks if required before adoption is considered. The Kitimat Community Humane Society has the right to refuse any application or adoption after careful review and is not required to give a reason for any application or adoption turned down. The Kitimat Humane Societies goal is to carefully screen all homes for the animals that are in their care, to ensure safe, loving environments with owners that are able to provide all of the pet’s needs and requirements. We try our best to place every animal into the best fit environment based on their own individual needs. Please now that we work as quickly as we can to help you add a new family member to your household but it could take a few days to complete the process before you are contacted. Disclaimer* I agree that all the above information is true I understand that there is a $375 adoption fee if my application is approved. This iframe contains the logic required to handle Ajax powered Gravity Forms.