Adoption Application

Following is a printable adoption application for you to fill out for the animal you would like to call your own.  In your web browser go to File, then Print. You can fax the form to us at (518) 828-7709, or mail it to CGHS, 125 Humane Society Road, Hudson, NY 12534.  Note:  If you mail the form, other applications may be received before yours!

Animal's Name(s):__________________________ Animal's#(s)__________________Date:_______________ ________________________________________________________________________________________

Name and Address of adopter(s):______________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________

Name of road if different from mailing address: __________________________________________________

Home Phone:________________________________ Work Phone:__________________________________

Are You 21 years of age or older? ______ Yes ______No

Does anyone in the home have allergies to animals? ______________________________________________

How many people live in the household?____________ Children's Ages:_____________________

Indicate the type of area you live in:____City _____Town _____Country/farm

Please indicate which of the following best describes your home:_____house _____mobile home _____apartment

If you live in a mobile home, is it privately owned property? _____Yes _____No

Please indicate if you RENT or OWN your residence (please circle one)

If you rent, please state your landlord's name and phone number:_____________________________________________________

Section 1: HISTORY OF YOUR PET(S) 1. Please list all pets, live or deceased, that were owned by anyone in your household in the past five years.

2. If you no longer have any of the above pets, please explain what happened to them: ____________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________

3. Have you previously adopted an animal from a shelter? _____Yes _____No Have you ever brought an animal to a shelter? _____Yes _____No

4. Veterinary Information

(a) Please state the name of your veterinarian: _______________________________________________________________

(b) When was your last visit to the )vet?____________________________________________________________________

(c) What was the reason for your visit?_____________________________________________________________________

(d) May we use your vet as a reference? _____Yes _____No

(e) Are your pets listed under your name? _____Yes _____No,

If not, whose name are the records in? ___________________________________________________________________________________________________

Section 2: FOR CAT ADOPTION

1. Cat will be: _____indoor only _____outdoor _____combination

2. Do you plan to declaw? _____Yes _____No

Section 3: FOR DOG ADOPTION

1. Do you have a completely fenced yard? _____Yes _____No

2. Where will the dog be kept during the day? ____________________At night?_____________

3. Dog will be alone for _____hours each day (average)

4. Would you be interested in attending dog training classes? _____Yes _____No

In an emergency, if something should happen to you and/or you are no longer able to care for the pet(s), who will be the caretaker of your animal(s)? ______________________________________________________________________________

_____________________________________________________________________________________________________________________

By signing this adoption application, I am accepting all risks associated with handling animals during the adoption process.

I also further attest that the information given is true. I realize that giving false information may result in being denied.

I agree to release all veterinary records pertaining to anyone in my household.  I realize that I must come to CGHS to visit 

this pet before approval, and that I will be required to pick up the pet at CGHS at adoption.

Signature 1:_________________________________________________________Date:_____________________