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Dog Adoption Application

To be considered to adopt a pet, you must:

BE AT LEAST 21 YEARS OF AGE
HAVE VERIFIABLE PHOTO IDENTIFICATION
UNDERSTAND THAT STEVENS-SWAN HUMANE SOCIETY RESERVES THE RIGHT TO DENY THE ADOPTION AT THEIR DISCRETION
NOT DISPLAY SIGNS OF INTOXICATION
SOME DOGS CAN ONLY GO TO HOMES WITH A SECURE FENCED IN YARD.

Please fill out this application in its entirety.

Download PDF of Dog Adoption Application

DISCLAIMER: Filling out the application does not guarantee an adoption.

Dog Adoption Application

Step 1 of 4

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To be considered to adopt a pet, you must:

• Be at least 21 years of age

• Have verifiable photo identification (benefit card, work ID or student ID not accepted)

• Understand that Stevens-Swan Humane Society reserves the right to deny the adoption at their discretion

• Not display signs of intoxication

WE WILL NOT ADOPT TO HOMES WITH RESIDENTS THAT HAVE A VIOLENT CRIMINAL RECORD.

• Please be advised that some dogs will not be adopted to homes with small children or other pets based on staff temperament assessment.

• SSHS reserves the right to withhold approval of this adoption pending a site visit to the home.

• SSHS is the current owner of the animal and reserves the right to deny adoption for any reason.

FALSIFICATION OR OMISSION OF ANY OF THE ABOVE INFORMATION WILL RESULT IN AUTOMATIC REFUSAL OF ADOPTION, OR CONFISCATION OF THE ANIMAL POST-ADOPTION.
Name of the dog you are interested in adopting*
Personal Information
Name*
First Last
Address*
NO P.O. BOXES

Street Address Address Line 2 City State ZIP Code
Email*
Phone*
Employment Type*
- Full Time
- Part Time
- Self Employed
- Retired
- Other
Place of Employment*
Work Phone
Self Employed - Name of Business/Company*
Other - Please Explain*
Verifiable Source of Income*
Spouse's Employment Type
- Full Time
- Part Time
- Self Employed
- Retired
- Other
Spouse's Place of Employment*
Work Phone
Self Employed - Name of Business/Company*
Other - Please Explain*
Verifiable Source of Income*

About You
Are you at least 21 years of age?*
- Yes
- No
If under 21, please stop here. You must be at least 21 years of age to adopt a pet from the Stevens-Swan Humane Society.
Please upload a copy/photo of your driver's license
Accepted file types: jpg, jpeg, gif, png, pdf, Max. file size: 64 MB.
Do you live in a*
- House
- Apartment
- Mobile Home
- Dormitory
Do you*
- Rent
- Own
- Rent To Own
- Dormitory
- Live With Parents
Landlord's Name*
Landlord's Phone*
Are you planning on moving in the next 6 months?*
- Yes
- No
- Maybe
How long have you lived at this address?*
How many people live in the household?*
Do all members know you plan to adopt a pet?*
- Yes
- No
Please list the names of all people over 18 in the household*
Please enter one name per line
List the ages of any children (under 18) living in the household*
Do any members of the household have allergies to animals?*
- Yes
- No
Is this pet specifically for this household?*
- Yes
- No
Please explain*
Sorry, you must be at least 21 years of age to adopt an animal from the Stevens-Swan Humane Society. You cannot continue with this application

About Your Pets
Have you previously owned pets?*
- Yes
- No
Please proceed to the next page
How many dogs have you owned in the past 5 years?*
Where are they now?*
- At home
- Deceased
- Given Away
- With parents
How many cats have you owned in the past 5 years?*
Where are they now?*
- At home
- Deceased
- Given Away
- With parents
Do you own pets at this time?*
- Yes
- No
How many dogs?*
Breed(s) of dog(s)*
Current dog(s) name(s)*
How many cats?*
Current cat(s) name(s)*
Do your pets live inside, outside, or both?*
- Inside
- Outside
- Both
Are your pets vaccinations up to date?*
- Yes
- No
Is/Are your dog(s) licensed*
- Yes
- No
Are your pets spayed or neutered?*
- Yes
- No
Why not?*
Has/Have your cat(s) been FIV/FeLV/HW tested?*
- Yes
- No
Your veterinarian's name*
Veterinarian's Phone Number*
Are there other animals living in your home that you do not own?*
- Yes
- No
Please list owner and veterinarian information*

About Adopting
What size dog are you considering?*
- Under 20 Pounds
- 21-50 Pounds
- 51-80 Pounds
- 80+ Pounds
Have you previously owned the breed of dog you are considering?*
- Yes
- No
Have you researched the breed's care/exercise requirements?*
- Yes
- No
Why are you adopting?*
Check all that apply
- Companion
- Gift
- Guard
- Hunting/Farm
Where will this dog live?*
Check all that apply
- Inside
- Outside
- Barn
- Dog House
Is your yard completely fenced in?*
- Yes
- No
Type of fence*
Height of fence*
Do you plan on enrolling this dog in any type of training?*
- Yes
- No
Where will the dog stay when alone?*
Where will the dog stay at night?*
How many hours will the dog spend alone each day?*
Where will this dog stay when you are away on business or vacation?*
Most shelter animals have unknown medical backgrounds.
Are you willing and able to provide veterinary care for medical treatment?*
- Yes
- No
Initials*
Are you aware that routine veterinary care typically costs $400 per year on average?*
- Yes
- No
The average lifespan of a dog is 10-18 years. Are you prepared to provide this pet a home and necessary care for the remainder of its life?*
- Yes
- No
Should you be unable to keep this pet, do you understand that you are LEGALLY bound to return it to the Stevens-Swan Humane Society?*
- Yes
- No
Initials*
Have you adopted pets from SSHS before?*
- Yes
- No
How many dogs?*
How many cats?*
Where are they now?*
Have you ever been denied an adoption from SSHS or any other organization?*
- Yes
- No
Explain*
Are you aware that by adopting from SSHS, you are signing a legal contract binding you to pet ownership responsibility, providing and paying for veterinary care, treating the animal humanely, etc.?*
- Yes
- No
Have you or anyone living in the household ever been convicted of a crime involving animals, or had your animals seized for abuse/neglect or unsanitary conditions?*
- Yes
- No
- Please be advised that some cats will not be adopted to homes with small children or other pets based on staff temperament assessment.
- SSHS reserves the right to withhold approval of this adoption pending a site visit to the home.
- SSHS is the current owner of the animal and reserves the right to deny adoption for any reason.
FALSIFICATION OR OMISSION OF ANY OF THE ABOVE INFORMATION WILL RESULT IN AUTOMATIC REFUSAL OF ADOPTION, OR CONFISCATION OF THE ANIMAL POST-ADOPTION.
Signature*
Enter your name
First Last
Date*
Today's Date
MM slash DD slash YYYY
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Comments
This field is for validation purposes and should be left unchanged.

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SHELTER LOCATION

Stevens-Swan Humane Society

5664 Horatio St.Utica, NY 13502Off of Route 12 NorthJust past the Riverside Center

Phone: (315) 738-4357

SHELTER HOURS

Tuesday-Friday: 11:00am-5:00pm
Saturday: 11:00am-4:00pm
CLOSED SUNDAY & MONDAY

Messages are checked periodically throughout the day for reports of lost pets.

<img src="https://stevens-swan.org/wp-content/uploads/2015/05/logo2.png" alt="Stevens-Swan Humane Society" />

Stevens-Swan Humane Society is a 501c3 organization and all donations are tax deductible.

Stevens-Swan Humane Society © 2015 | All Rights Reserved

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