The Humane Society of Somerset County, Maryland

PO Box 493
Princess Anne MD 21853
(410) 651-2424
7922A Crisfield Hwy.
Westover, MD 21871

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The Humane Society of Somerset County, Maryland

Our mission is to prevent cruelty to animals, promote respect for their intrinsic value, eliminate pet overpopulation and enhance the bond between humans and animals.

Adoption Application

Fill out this form to submit your application Online, or print out the application and bring it with you.

Terms of Adoption

1. Animals adopted through the Humane Society may not be sold, given, traded, or otherwise transferred without the written permission of the Humane Society, in advance.

2. You must comply with all laws in your local County code for pet ownership, treatment and care, now and in the future.

3. You must adhere to the Humane Society's Adoption Policy as presented.

The Humane Society requires a non-refundable donation of thirty-five ($35.00) dollars for each cat or kitten adopted through us. The donation helps to offset administrative and medical costs.

Name Email Address

Street

City State Zip

Phone

Is it okay to call you at work? Yes No

Why do you want to adopt a cat or kitten?

Have you owned, or do you own any pets? Yes No

If yes, how many pets do you currently own?

Cats Dogs Other

What are their names?

Are they spayed or neutered? Yes No

If No, why not?

Who is your veterinarian?

Vet's location: Phone:

Are there children at home? Yes No

If yes, what are their ages?

What is your living situation? Own home Rent apartment Other

If Other, please explain:

If you rent, we will need your landlord's permission in writing, or a copy of your lease regarding pets.

Where will your cat or kitten sleep?

Are you looking for a particular breed of cat? Yes No

Are you considering adopting a particular cat or kitten? Yes No

If yes, what is it's name?

Where did you see the cat or kitten?

HSSC web site Petfinder.com An adoption event

Cage at vet's or Ace Hardware Newspaper

Other

Would you consider adopting an older cat, or a cat with special needs?

Yes No

Would you consider adopting a mixed breed cat or kitten?

Yes No

Are the members of your household aware that you wish to adopt a cat or kitten?

Yes No

Can you assume the financial responsibility of owning an animal, including vaccinations, vet care and good quality food?

Yes No

Please give an estimate of yearly costs for

FOOD MEDICAL

Are you planning to move in the near future?

Yes No

Are you familiar with the animal regulations in your area including Homeowner Association rules and landlord rules which may apply to pet ownership?

Yes No

Adoption Contract

By typing my name below I certify that the information herein is complete and true. I understand that providing false information will void the adoption. I further understand that failure to comply with the terms of the adoption may result in the Humane Society's retrieval of the animal with no reimbursement of fees.

I understand and accept the Terms Of Adoption as presented above.

I have read and understand the Adoption Policy.

I agree to pay The Humane Society of Somerset County, Maryland a non-refundable donation of thirty-five ($35.00) dollars for each cat or kitten adopted.

I agree to supply my landlord's permission in writing or a copy of my lease, if needed.

I agree to sign a printout of my application when I receive my new pet.

Typed Name(s) of Adopter(s)

Date Submitted