Adoption Application ** Our adoption staff will contact you as soon as your application has been processed ** First Name * Last Name * Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCôte d'IvoireCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthelemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Primary Phone * Alternate Phone Email * Today's Date What is your age? * Under 18 Over 18 Primary Residence * Own Rent Live with Parent If you rent, do you know your pet policy? Yes No Do you have children under 10 years of age living in or frequently visiting your home? * Yes No Does every member of your household know about and agree with your intentions to adopt? * Yes No Tell us about any animals you currently own. * Name(s), type, breed, age, and number of years owned Tell us about any animals you have owned in the past. * Name(s), type, and number of years owned Name of animal you wish to adopt. * If unknown, please include what type of animal you wish to adopt Where will your adopted pet spend most of its time? Where will the pet be when you are not home? Please explain in as much detail as possible. * Indoor only, indoor/outdoor with fenced in yard, indoor with a screened patio, outdoor only, etc... What is your pet's ideal energy level? * Able to run/hike but relax at home, low energy, extremely active, couch potato, etc... How much do you know about heartworm disease? * Are your dogs and/or cats spayed/neutered? * Yes No Other (ex: some, not yet, etc...) I do not have any current pets If you are interested in adopting a cat or kitten, do you plan to declaw? * Yes No Unsure I am not interested in adopting a cat or kitten What is your veterinarian's name & phone number? * This can be a current, past, and/or future veterinarian. Please write N/A if you do not have a vet. Have you ever given up a pet before? * Rehomed to another person, surrendered or returned to a shelter, etc... Yes No If you selected yes, please describe the situation. How long ago, to where did you rehome, circumstances, etc... If your adopted pet goes missing and you cannot be reached, who would you like as your emergency contact on the microchip? * Please include full name and phone number(s) How did you hear about us? FOOTHILLS HUMANE SOCIETY ADOPTION QUESTIONNAIRE * I hereby acknowledge and agree to the following: 1. I understand that I have ten (10) days to return the animal for a full refund. If the animal is found to be ill or unhealthy within 21 days, I understand that I may return it to Foothills Humane Society (hereinafter “FHS”) with the veterinarian’s diagnostic statement confirming the health problem. I understand that I may then choose another animal. Once returned to FHS, I will have a six (6) month period of time to exchange this animal for another animal of equal adoption fee value. 2. FHS is committed to the animal’s well-being for the remainder of its life. If at any time I cannot provide for this animal, I agree to notify FHS and will not surrender the animal to another shelter or re-home the animal without written authorization from FHS. 3. I agree to provide current vaccinations against diseases in accordance with local and state laws. I agree to comply with any city and/or county animal laws and ordinances as required by law. 4. I agree to humanely care for and provide proper food, water and shelter for any animal, including routine periodic veterinary examinations and monthly heartworm prevention (dogs only). 5. I agree to keep the adopted animal as a household companion at my residence. 6. I acknowledge that dogs cannot be trusted off-leash except in enclosed areas. Therefore, I will NOT permit the animal to run free or off-leash in public area. The adopted companion will not be 'tied-out' or 'staked out' or 'penned out' for extended periods of time. 7. For cats, I agree that I will NOT have the animal declawed. 8. I agree that I will NOT transport companion animal in an open truck bed or boat without appropriate restraints. 9. I agree that the animal will NOT be used for fighting, baiting, medical experimental or sacrificial purposes. 10. I agree that if the animal is stolen or missing, I will notify FHS within three (3) days. 11. I understand that in the instance that I am “fostering” or “fostering to adopt,” the animal remains the legal property of FHS and I may not surrender it to any other animal shelter or animal welfare organization. I further agree that I am required to bring the animal to the shelter for any required medications prescribed by FHS, i.e. heartworm treatment, as scheduled by FHS. 12. I understand the FHS reserves the right to reclaim an animal adopted from FHS if there is any violation of the terms of this agreement or if FHS has factual information that the animal is not being properly cared for and/or is in abusive or dangerous circumstances or environment. The adopter will not have the right to contest this action, and will be banned from adopting any other animals from FHS. 13. I release FHS from all liability for injury or damage sustained while adopted or fostered animal is in my possession. 14. Though care is given to physical condition and temperament evaluation of each animal that is accepted by FHS and every reasonable effort is made to provide a rescued animal which is compatible with adopter's home, no warranty is made to the physical condition or temperament of adopted animal. FHS will fully disclose animal’s medical and behavioral history as far is known by FHS. 15. As of the date of receipt of the animal, I assume full responsibility for the adopted animal's actions and shall hold FHS and its individual members harmless for all claims for personal injury to others, and/or property damage associated with adopted or fostered animal while animal is in my possession. 16. I agree to pay FHS the adoption fee and understand that any sum I have given for the adoption of this animal is not refundable as it is a donation toward FHS’ care for this and other animals by FHS. 17. I hereby accept possession and responsibility of and for the animal identified to be adopted above, at my own risk, and hereby covenant and agree not to sue or assert any claim, demand or action against or with respect to FHS for myself and/or others, directly or indirectly, regarding or arising from this animal and hereby hold harmless, release and waive any right or claim against FHS, which I or others now or in the future may have for any damages or injuries to person or property caused by said animal. ** A valid driver's license will need to be presented at the time of adoption for identification purposes. ** I have read and understand this agreement and will comply with the provisions set forth therein. Captcha If you are human, leave this field blank. Submit Δ