Please complete prior to viewing our available animals

Applicant Information

Name (first, middle, last):

Address:

City:,   State:   Zip:

Home Ph:   Work Ph:   Cell Ph:

Email:

We are glad you are considering adopting a new pet through HSSET. The following information is requested so that your adoption counselor may assist you in the selection of a new pet. The consultation process is designed to help us determine if the adoption is in the animal's best interest and to assist you in finding an animal most compatible with your lifestyle.

To Be Considered A Potential Adopter, You Must:

• Be 18 years of age or older;
• Have identification showing your present address;
• Have the knowledge and consent of your landlord and can be reached by our staff prior to adoption;
• Be able and willing to spend the time and money necessary to provide vaccinations, medical treatment, training and proper care for a pet;
• Agree not to chain the animal outdoors;
• Not be adopting an animal for a Gift or on behalf of someone else;
• Not have had an animal who has died of any contagious disease within the last 6 weeks;
• Return the animal to Humane Society of Southeast Texas, if, for any reason, you are unable to keep;
• Consent to a home visit, with prior notice at a mutually agreed upon day and time:

If You Meet The Above Qualifications, Please Complete The Following:

I am interested in adopting a:
Dog   Puppy   Cat   Kitten

I would like to adopt a:
Male   Female   Either

Name(s) of the animals you are interested in adopting:

Why are you interested in this/these particular Pet(s)?

Is this your first experience with a pet? Yes   No

Please check any of the following reasons you wish to adopt a pet:
Watchdog   Companion   Barn Animal
Breeding   Hunting   Family Pet   Child's Pet
Guard Dog for Business   Companion for another pet
Other (please specify below)

If other reason for adoption specify your reasons here:

When home alone, the animal will be:
In a crate
In an outdoor kennel or pen (specify size below)
Loose indoors
Loose outdoors
Tied up outdoors
Other (please specify below)

Other provisions or size of enclosure:

Do you own any pets at the present time? Yes   No

If yes, please list the following:
Name, Breed, Age, Sterilized, Declawed, Inside or outside

How many dogs or cats have you owned in the past 5 years?
Dogs:     Cats:

What other pets have you owned in the past 5 years?

What happened to those pets?
(Be specific, include name, breed, ages, health, died of old age, fatal disease, sterilized, hit by a car, stolen, disappeared?)

Have you ever given up an animal? Yes   No

If yes, please state reason:

Who is your veterinarian?

What is your veterinarian's phone number?

May we call your veterinarian for a reference? Yes   No

Do you currently reside in a:
House   Apartment   Mobile Home   Duplex   Condo   Other

Do you: Own?   Rent?

If you rent, does your lease allow pets? Yes   No
Please note: must have landlord approval PRIOR to leaving the shelter with your new pet.

If you rent, what is your Landlord's Name:

If you rent, what is your Landlord's Phone:

How long have you lived at the above address?

How many people live in your household?

Do all the adults know that you plan to adopt? Yes   No

If there are children in the household, what are their ages?

Is anyone in your household allergic to animals? Yes   No

Is your new pet going to be an indoor or outdoor pet?
Indoor   Outdoor

What type of preventative do you use for fleas?

Are you aware of Heartworm Disease and will you ensure your pet is protected monthly? Yes   No

What type of preventative do you use for heartworms?

Do you have a dog-door? Yes   No

Is your yard fully fenced? Yes   No

How high is the fence? feet

What will you do with this pet if you move?

What will you do if you become financially/physically unable to care for the animal?

How did you hear about HSSET and/or this Pet Adoptathon?

By my action of submitting this form I certify that the above information is correct and clearly understand that providing false information can result in the Forfeiture of the adopted pet.

NOTE:
HSSET is not able to grant every application for adoption and reserves the right to reject an application. Our adoption counselors are well trained and are required to ask for detailed information about the potential living arrangements (and may require a home check) for our animals. Applications are processed on a first come-first serve basis, but are approved based on which application is the best match for the animal. We have set guidelines for application acceptance, and understand that opinions may differ from ours. We commend you for understanding and your desire to save a shelter animal!

go to the Humane Society of Southeast Texas Home

Humane Society Contact
(409) 833-0504 or (409) 722-0605
P. O. Box 1629   ·   Beaumont, TX 77704-1629
2050 Spindletop Road   ·   Beaumont, TX 77705

Adoption Hours
Tuesday - Saturday 11:30 a.m. - 5:00 p.m.
Closed Sunday and Monday