Cash Amount
Check #
Driver’s License #
Date
Fostered By
Animal Name
Animal Age
Animal Sex MaleFemale
Breed
Color
Adopter’s Name
I am at least 18 years old YesNo
Veterinarian Name
Housing Situation Own HomeRentRoommateLive with Parents
If renting, how big is your home?
Why do you want to adopt this animal?
If you move, what will you do with this animal?
I understand a pet is a 15–20 year commitment YesNo
What will you do if this animal does not get along with your other animals?
Do you have other pets? YesNo
If yes, why?
How do you feel about declawing cats?
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List Other Pets in Household
Special Needs (if any) Must have fenced yardNo children in homeNo other pets in homeMust live inside alwaysOther special needs
Medications
I understand that if I cannot keep this animal, I must return it to Columbus Humane Society.
I agree to open communication and return phone calls regarding the animal’s wellbeing.
I understand I have 14 days for a full refund; after that no refund is available.
I understand Columbus Humane Society makes no guarantees about health or temperament.
I understand obedience classes are recommended for adopted dogs.
I certify all information is true and understand false information voids this adoption.
Adopter Signature
Second Adopter Signature (optional)
Witness (CHS Member)
