A Program of the Central Pennsylvania Animal Alliance
	Application to Adopt Izzie Pet's Name:  Name(s)  Address  City/State/Zip  Location if Rural Address Number of Persons at this Address: Adults    Ages  Children    Ages  Phone Number   Best Time to Call  Driver's License No. Employer  Employer Address  Employer Phone  Do you own,    rent   or    live with your parents? Please select the type of home you live in:  Apartment House Trailer Landlord's name and phone number (if applicable): Are you interested in adopting a dog  or cat? Is this your first animal?   Yes    No Are you aware of the yearly cost of maintaining your pet's health?  Yes    No How long will animal be left alone?  Where and how will this animal be kept in your absence?  Describe your yard Approximate size: Fence type and height: If the yard is not fenced in, how will you ensure that the dog does not stray? Please provide the following for your current pets: (type of pet, name, age, gender, spayed/neutered, current on vaccines) Pet #1 Pet #2 Pet #3 Pet #4 Pet #5 Where do you keep your pets?  Inside       Outside       Both (Inside & Outside) Where do you intend to keep this pet?  Inside     Outside   Both (Inside & Outside) Have you or any family member ever surrendered animals to a shelter/rescue?  Yes  No If yes, please explain. Veterinary References Veterinarian   Phone Address  Please list four references we may contact who know you personally and who do not live in the same household as you: Name       Phone  Name       Phone  Name       Phone  Name       Phone  By submitting this application I certify that all statements are true and correct.  I give permission to the Huntingdon County Humane Society to check with my employer, veterinarian, landlord and references.  I understand that if declined for adoption that I have the right to request a review before an adoption review committee.
	Hounds of Prison Education A Program of the Central Pennsylvania Animal Alliance