All rights reserved.
Have you submitted your application fee?
Yes
No
Date
Name of animal for which you are applying
Name
Address
City, State, Zip
Home Phone
Cell Phone
Work Phone
Place of Employment
Please provide your valid email address
If leasing, Complex/Landlord Name & Phone
How long have you lived at the above address?
Check one for your current housing
House
Apartment
Mobile Home
Condo
Do you ?     Own
Rent
Pets Accepted?
Weight Limit
Deposit Paid?
Amount of Deposit?
Do you foresee moving in the near future?
How many people live in your household?   Adults
Children
Ages of children?
Do all members know that you plan to adopt a pet?
Yes
No
Are you or your spouse employed?
Yes
No
Are you 21 years of age or older?
Yes
No
Do you smoke?
Yes
No
Inside
Outside
Do you live with your parents or relatives?
Yes
No
Does anyone have pet allergies?
Yes
No
If yes, what kind?
For whom are you interested in adopting?
Self
Family
Someone else
Why do you want a pet?
Companion for self
Companion for other pet
Gift
Childs pet
What kind of pet is this going to be?
Family pet
Yard pet
Watch dog
Hunting
Is being housebroken required?
Yes
No
Do you currently have any pets?
Yes
No
Type of pet?
Sex, & age
Have you had any pets in the past five years?
Yes
No
How many?
What Breed of Dogs do you currently own?
Where are they now?
Has a do or cat died on your premises in the last three months
from FIP, FIV, FELV, Distemper, Parvo, or unknown causes?
Yes
No
If yes, what did he/she die from?
Where do your present pets live?
Indoors
Outdoors
Where will your new pet live?
Indoors
Outdoors
Where will your new pet sleep?
Indoors
Outdoors
Basement
Garage
How will your new pet be exercised?
Walking
Running
Runner chain
Is there a completely fenced yard available?
Yes
No
How high is the fence & what is it made of?
Are the gate secured by locks?
Yes
No
Are your present pets up to date on their shots, and spayed/neutered?
Yes
No
Do you object to spaying or neutering?
Yes
No
Name and phone number of you Veterinarian or clinic.
What do you think annual preventative Veterinary care for a pet would cost?
What do you plan to do with your pet when you go on vacation?
What procedures will you use for destructive behavior?
What will you use for flea and tick prevention?
What will you use for heartworm prevention?
May an East Coast Humane Society Inc. representative inspect the
premises where the animal will be kept both before, and after adoption?
Yes
No
What brand of pet food do you plan to feed your new pet?
Have you ever taken an animal to a shelter before?
Yes
No
How many?
Please explain why you took an animal to a shelter.
Can you afford three times the cost of the adoption fee for veterinary care on this animal?
Yes
No
For what reason would you justify giving up your pet?
Personal reference: name, address, phone number.
I understand that it can take up to four
business days to process my application
Yes
No
Please note: East Coast Humane Society Inc. is an independent non-profit organization. We will in no way be held responsible for
any adult, minor child, and/or their property during the viewing process. In signing this form, you attest that you agree to release east
Coast Humane Society Inc. and its representatives from all liability for any property in your party while in the adoption area.
Please Note. You need to submit your application first, and then
submit the application fee separately!  If you do not do it in this order,
your application may not be received. Also add us to your contact list
or our emails might end up in your spam folder.
It can take up to four business days to process your application.
Please give us time to contact you.
I attest that the above information is true and accurate.
Yes
Counter
Process

Application fees are Tax deductible but
Non refundable.
To be considered for one of our pets, you will need to submit an application and a $10.00 processing fee through
PayPal. This fee must be submitted for us to review your application. We have limited time and limited staff and
this shows that you are truly interested in one of our K9 friends. Please click on any of the buy now buttons on this
page or the application page to process your application fee.
Most of our dogs are located in Florida, but can be transported to your state for an additional transportation fee.
We receive several applications for the same dog. Paying an application fee and submitting an application does
NOT entitle you to adopt from East Coast Humane Society.
We give preferential treatment to those with an excellent Vet reference
.