Humane Association of the Lowcountry - Adoption Application Form

1) Our Mission

The Humane Association of the Lowcountry (HAL) is devoted to enhancing the lives, adoption rates and experiences of homeless cats and dogs living in Beaufort County, SC. The amount of support we can provide is limited primarily by donations, availability of rescuers and foster families as well as forever homes. HAL is all-volunteer non-profit charity and a fund of the Community Foundation of the Lowcountry (CFL). 98% of our monetary donations are used to help the animals. We do not have a permanent facility. We are a small organization and most volunteers work independently out of their homes.

Thank you for your interest. The Adoption Application should take you about 10 - 15 minutes to complete.

2) Applicant(s)

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Home Phone*

Work Phone

Email*

Enter Email Confirm Email

Age*

Please enter a number from 18 to 100.

Please list any allergies or physical, medical (including pregnancy), and psychological limitations or disabilities that might hinder you or any member of your family from giving an animal a "forever home".

Have you had a tetanus or booster shot within the last five (5) years?

Yes
No

Have you been convicted of a felony or misdemeanor associated with animal abuse or neglect within the last seven (7) years?

Yes
No

Explain:

Co-Applicant Name

First Last

Co-Applicant Home Phone

Co-Applicant Work Phone

Co-Applicant Email

Enter Email Confirm Email

3) Home Information

How long have you lived at this address

Which best describes your home:

If you selected "Other," please explain:

If you are renting, please list your landlord's name and phone number. HAL will contact them by phone to discuss their pet policy:

Previous Address (If less than two years)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

4) Please list the ages of all children in the home or who visit:

List Children

(Or enter "not sure.")

5) Please list all other members living in your household (names and ages):

List other adults

(Or enter "not sure.")

6) Are you interested in a specific animal?

If so, please indicate the name

Gender:

Male
Female
Either

Age:

Adult
Young
Either

A particular breed?

7) Animals in the Household:

Total number of pets owned in the last three (3) years:*

Pet Information

Cat, Dog, Other	Name	M/F	Age	Pet is D=deceased, R=rehomed, H=home	Vaccines up to date (Y/N)?	Spayed or Neutered (Y/N)?	Vet Name	Vet Address	Vet Tel

NOTE: To add more Rows/Pets click on the red plus sign at the end of the row.

Comments

8) References:

Reference Name 1

First Last

Reference Address 1

Street Address Address Line 2 City State ZIP Code

Reference Phone 1

Reference Email 1

Comments 1 (Describe your relationship with reference 1 as it relates to animals)

Reference Name 2

First Last

Reference Address 2

Street Address Address Line 2 City State ZIP Code

Reference Phone 2

Reference Email 2

Comments 2 (Describe your relationship with reference 2 as it relates to animals)

9) Why do you wish to bring a new pet into the home?

10) Is everyone in your household in agreement about adopting a new pet?

Agreement:

Yes
No

11) Is anyone home during the day?

Daytime:

Yes
No
Sometimes

12) Is anyone home during the night?

Nighttime:

Yes
No
Sometimes

13) Will you board or have a pet sitter when you are away?

Boarding/SItting plans:

14) What type of training do you plan to provide?

Training plans:

15) Will your pet have a safe place?

Will your new pet have a place to go that is free of children, dogs, other cats, etc?

Yes
No

Please describe the area or why not?

16) Is your intention for this pet to be inside or outside?

Is your intention for this pet to be inside or outside?

Inside only
Outside Only
Inside at night, Outside during the day
Other

If not inside only, please explain

17) Are you planning to give this pet as a present?

Gift?

Yes
No

If yes who are you planning to give this pet to? (relationship)

18) Under what circumstances would you give up your pet?

Justification for giving up:

19) Do you have anything you want to add to this application?

Additional comments:

20) Adoption Requirements

In order to adopt a HAL animal I must:

BE 18 YEARS OF AGE OR OLDER.
Have identification showing your present address (e.g., drivers license, utility bill)
Have the knowledge and consent to adopt from all adults living in your household.
Have the knowledge and consent of your landlord or the person owning the premises in which the animal will live.
Understand that this application is the property of HAL and will be retained in its files.
Understand that HAL has full authority to approve or deny your application.
Understand that HAL reserves the right to verify all information submitted on this application, including veterinary information.
Understand it is my responsibility to provide a safe, warm, indoor housing for animal(s).
Understand that animals allowed to go outdoors need monthly flea, tick, and heart worm treatments.
Understand that I must provide quality food and access to water at all times.
Understand that I must slowly introduce a new pet to my existing pet(s).
Understand that I must spend time playing with and training the new animal(s).
Understand that I am responsible for bringing the animal(s) to the Vet for vaccinations, physicals, and medical treatment.
Understand that I must closely monitor the condition of the animal(s) and contact my Vet immediately when problems are observed.
UNDERSTAND THAT I MAY NOT TRANSFER OWNERSHIP OF ANY ANIMAL ADOPTED FROM HAL TO ANOTHER PARTY. IF I MUST RELINQUISH OWNERSHIP OF ANY ANIMAL THAT I NEED TO CONTACT A REPRESENTATIVE OF HAL TO RETURN THE ANIMAL or DISCUSS ALTERNATIVES.
Understand that in handling animals there exists a risk of injury, infection, disease including physical harm caused by animals to me, my family or my pets. On behalf of myself, my heirs, personal representatives and executors, I hereby release, discharge, indemnify, and hold harmless HAL, its agents, servants and board from any and all claims, causes of actions, or demands and any nature of cause, including costs and attorney fees incurred or sustained by me in any way connected with my services to HAL but not limited to: animal bites, accidents, injuries, property damage and veterinary fees.

Date

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