Okanagan Humane Society (“OHS”)

Pet Adoption Application

Name______

Address______City______PC______

Email______Phone – Home______Cel______

Residence…Do you Own or Rent? House____Apartment____Condo____ Townhouse______

(Please circle)

How long have you been at this address? ______Are you a Student? ______

Are you employed? ______You age group: 19-25___26-37___38-48___49-65___66+___

Married_____Single_____Roommates_____Do roommates have aninals?______

Are Pets allowed by the Landlord______How many cats allowed?______dogs?______

Landlord’s name and phone number______

Do you have any existing pets? ______If no, have you had a pet in the last ten years?______

What is the type, sex and age (if any) of your existing pet?______

______

What happened to the pets no longer in your care? ______

______

Are your pets spayed/neutered?______Are your pets vaccinations up to date?______

What are the ages of your children?______Any allergies?______

Will you provide a scratching post?______Who is you Veterinarian?______

How many hours per day will the pet be alone?______What are your reasons for adopting?

______

Please read and initial beside all terms and conditions describedand agreed to below(see below)*:

I Agree that:

(i)All animals in my possession, will be treated humanely and kept

indoors to protect them from busy roads, poisons and predators.______

(ii)The named animal will not be taken to the SPCA or dumped as

Unwanted. If it is no longer wanted it will be returned to the OHS.______

(iii)The animal will NOT be declawed. ______

(iv)I can afford to support the animal and pay the veterinary bills.______

(v)I acknowledge after checking the animal it is in apparent good health. ______

Pet Information on the Pet you’re interested in adopting

Color______Name______Age______Birthdate______

Female Spayed___ Male Neutered___ Tattoo______Special Markings______

FUNDRAISING, FOSTERING, DONATIONS, AND MEMBERSHIP

Would you like to be contacted to help with either fundraising or fostering?______

Would you like to purchase anOHS membership for an extra $10.00?______

Would you like toadditional donation to The Okanagan Humane Society $______

All donations over $20.00 will receive a tax receipt.

Amount paid to the OHS for the adoption of this animal goes towards the veterinary and care costs incurred for its wellbeing, which is $ 160.00

Date______Adopters signature______

(print below)

*OHS Consent to Adoption Conditional On Approval of Adopter

All Adoptions are subject to OHS approval, which requires: (a) the review and approval of the OHS to the completed version of this Adoption Application Form,including the Adopter’s acceptance of the terms and conditions (i)–(v) of this Agreement;and, (b) an adoption interview (either by phone or in person) by an OHS representative of the Adopter, which is completed to the satisfaction of the OHS.

THANK YOU FOR HELPING US SAVE LIVES!