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2. Porter County Animal Shelter Online Adoption Application
4. Thank you for your interest in adopting a rescued pet. The following information is requested so that our adoption counselors can assist you in the selection of a new pet. The animal's welfare is our foremost concern. All questions with a red * required an answer. You will not be able to submit this form until all required questions are answered.
6. About You & Your Contact Information
8. Your First Name*
9. Your Last Name*
11. Do You Have A Spouse/Partner?*

    1. Yes

    1. No
13. Your Spouse/Partner First Name*
14. Your Spouse/Partner Last Name*
16. Your HOME Phone Number*
17. Your CELL Phone Number*
19. Your Email Address*
20. Your Driver's License or State ID #*
22. Your Street Address*
23. Apartment or Lot Number*
    Enter NONE if not applicable.
25. City*
26. State*
27. Zip Code*
29. Your Employer Name*
30. Your Spouse/Partner's Employer Name*
32. Are You A Senior (Age 55 Or Older)?*

    1. Yes
    2. No
34. Our Seniors For Seniors adoption program was developed to help senior humans rediscover the joys of having a dog or cat in their lives, and the program places senior cats and dogs (typically over 7 years of age) with senior citizens who are 55 years of age or older. Our knowledgeable staff will help you select a companion who fits into your lifestyle and housing situation and our ADOPTION FEE WILL BE WAIVED, subject to an approved adoption application.*

    1. YES, I am interested in the Seniors For Seniors Adoption Program
    2. NO, I am NOT interested in the Seniors For Seniors Adoption Program
36. Are You A Veteran or Active Duty Military?*

    1. Yes

    1. No
38. Our Pets For Vets adoption program was developed to match Veterans with the right pet, changing both lives for the better. The Veteran saves the animal and welcomes him/her into a loving home. Our knowledgeable staff will help you select a companion who fits into your lifestyle and housing situation and our ADOPTION FEE WILL BE WAIVED, subject to an approved adoption application and proof of veterans' status.*

    1. YES, I am interested in the Pets For Vets Adoption Program
    2. NO, I am NOT interested in the Pets For Vets Adoption Program
40. Have You Ever Given Away A Pet For Any Reason?*

    1. Yes

    1. No
42. Please Explain Why You Have Given Away A Pet*
44. Have You Previously Owned A Pet?*

    1. Yes

    1. No
46. Have you seriously considered the costs involved with adopting a new pet, including but not limited to annual vet visits, food, toys, supplies, housing and damage to your property?*

    1. Yes

    1. No
48. Why have you decided to adopt?*

    Check all that may apply.

    1. House Pet
    2. Outdoor Animal
    3. Livestock Guardian

    1. Gift
    2. For Protection

    1. Companion For Self or Pet
    2. Other
50. If Other, please explain*
52. What best describes your household environment?*

    1. Calm & Quiet

    1. Many Visitors

    1. Other
54. If Other, please explain*
56. If approved, your new dog or cat needs to be good with:*

    Check all that may apply.

    1. Children Ages 8 And under
    2. Children Over 8 Years Old
    3. Elderly Persons

    1. Other Cats
    2. Other Dogs
    3. Animals Other Than Dogs Or Cats
58. What behaviors are you UNWILLING to work through with your new pet:*

    Check all that may apply.

    1. Accidents In The House
    2. Aggression Towards Pets
    3. Aggression Towards Kids
    4. Escaping

    1. Destructive Behavior
    2. Leash Issues
    3. Jumping On People
    4. Mouthing

    1. Food/Toy Aggression
    2. Vocalizing
    3. Willing To Work With All
60. Are You Interested In Adopting A Dog Or A Cat?*

    1. Dog
    2. Cat
62. Is there one or more dogs at the Shelter that you are particularly interested in adopting?*

    1. Yes
    2. No
63. Please list the name(s) of the dog(s) that you are interested in adopting.*
65. Are You Interested In A "Special Needs" Dog (Medical Or Behavior?)*

    1. Yes

    1. No
66. Are You Seeking A Guard Dog?*

    1. Yes

    1. No
68. Do You Have A Fenced Yard?*

    1. Yes
    2. No
69. Describe The Type Of Fence*
70. What Is The Height Of The Fence*
72. Please Complete This Question: It is most important to me that my dog....*
74. Is there one or more cats at the Shelter that your are particularly interested in adopting?*

    1. Yes
    2. No
75. Please list the name(s) of the cats(s) that you are interested in adopting.*
77. Describe the personality that best describes what you are looking for in a cat:*

    Check all that may apply.

    1. Independent
    2. Social
    3. Calm

    1. Playful
    2. Clingy

    1. Lap Cat
    2. Other
79. If other, please explain*
81. If You Have Had Cats, Have Any Of Them Been Declawed?*

    1. Yes
    2. No
83. Do You Plan To Declaw Your New Cat?*

    1. Yes

    1. No
85. Please Explain Why You Plan To Declaw Your New Cat.*
87. If Your Cat Became Destructive At Home, What Would You Do?*
89. CURRENT Pet Ownership Information
91. Do You Currently Own Pets?*

    1. Yes

    1. No
93. Provide The Name Of Your Current Veterinarian*
94. Veterinarian's Phone Number*
96. Are All Pets In Your Household Current On Vaccinations?*

    1. Yes

    1. No
98. What Species Of Pets Do You Currently Own?*

    Check all that may apply

    1. Cats

    1. Dogs

    1. Other
100. How does your dog react to meeting new dogs in public?*
102. How Many Cats Do You Currently Own?*
103. How Many Dogs Do You Currently Own?*
104. How Many Pets Of Other Species Do You Currently Own?*
106. In Order To Properly Evaluate Your Application, You Will Need To Provide Us With Information About Your Current Pets Below*

     1. I Understand & Agree
108. Pet #1 Name*
109. Pet #1 Species*
110. Pet #1 Breed*
111. Pet #1 Age*
113. Pet #1 Gender*

     1. Male
     2. Female
114. Is Pet #1 Spayed/Neutered?*

     1. Yes
     2. No
115. Is Pet #1 An Indoor Or Outdoor Pet?*

     1. Indoor
     2. Outdoor
117. Do You Own Another Pet?*

     1. Yes

     1. No
119. Pet #2 Name*
120. Pet #2 Species*
121. Pet #2 Breed*
122. Pet #2 Age*
124. Pet #2 Gender*

     1. Male
     2. Female
125. Is Pet #2 Spayed/Neutered?*

     1. Yes
     2. No
126. Is Pet #2 An Indoor Or Outdoor Pet?*

     1. Indoor
     2. Outdoor
128. Do You Own Another Pet?*

     1. Yes

     1. No
130. Pet #3 Name*
131. Pet #3 Species*
132. Pet #3 Breed*
133. Pet #3 Age*
135. Pet #3 Gender*

     1. Male
     2. Female
136. Is Pet #3 Spayed/Neutered?*

     1. Yes
     2. No
137. Is Pet #3 An Indoor Or Outdoor Pet?*

     1. Indoor
     2. Outdoor
139. Do You Own Another Pet?*

     1. Yes

     1. No
141. Pet #4 Name*
142. Pet #4 Species*
143. Pet #4 Breed*
144. Pet #4 Age*
146. Pet #4 Gender*

     1. Male
     2. Female
147. Is Pet #4 Spayed/Neutered?*

     1. Yes
     2. No
148. Is Pet #4 An Indoor Or Outdoor Pet?*

     1. Indoor
     2. Outdoor
150. Do You Own Another Pet?*

     1. Yes

     1. No
152. Pet #5 Name*
153. Pet #5 Species*
154. Pet #5 Breed*
155. Pet #5 Age*
157. Pet #5 Gender*

     1. Male
     2. Female
158. Is Pet #5 Spayed/Neutered?*

     1. Yes
     2. No
159. Is Pet #5 An Indoor Or Outdoor Pet?*

     1. Indoor
     2. Outdoor
161. Do You Currently Have Any Other Pets Not Listed Above?*

     1. Yes

     1. No
163. Shelter Staff Will Ask For Information About Any Other Current Pets Not Listed Above When You Are Called For A Phone Interview.*

     1. I Understand & Agree
165. PREVIOUS Pet Ownership Information
167. In The Past TEN YEARS, Have You Previously Owned Pets That Are NOT Currently In Your Household? This includes pets that are deceased or have been lost, stolen, sold or given way.*

     1. Yes

     1. No
169. What Species Of Pets Have Your Previously Owned In The Last Ten Years?*

     1. Cats

     1. Dogs

     1. Other Species
171. How Many Of Them Were Cats?*
172. How Many Of Them Were Dogs?*
173. How Many Of Them Were Other Species?*
175. In Order To Properly Evaluate Your Application, You Will Need To Provide Us With Information About Your Previous Pets Below, Including Pets That Are Deceased Or Have Been Lost, Stolen, Sold Or Given Away.*

     1. I Understand & Agree
177. Previous Pet #1 Name*
178. Previous Pet #1 Species*
179. Previous Pet #1 Breed*
180. Previous Pet #1 Age*
182. Previous Pet #1 Gender*

     1. Male
     2. Female
183. Was Previous Pet #1 Spayed/Neutered?*

     1. Yes
     2. No
184. Was Previous Pet #1 An Indoor Or Outdoor Pet?*

     1. Indoor
     2. Outdoor
186. Have You Previously Owned Another Pet?*

     1. Yes

     1. No
188. Previous Pet #2 Name*
189. Previous Pet #2 Species*
190. Previous Pet #2 Breed*
191. Previous Pet #2 Age*
193. Previous Pet #2 Gender*

     1. Male
     2. Female
194. Was Previous Pet #2 Spayed/Neutered?*

     1. Yes
     2. No
195. Was Previous Pet #2 An Indoor Or Outdoor Pet?*

     1. Indoor
     2. Outdoor
197. Have Your Previously Owned Another Pet?*

     1. Yes

     1. No
199. Previous Pet #3 Name*
200. Previous Pet #3 Species*
201. Previous Pet #3 Breed*
202. Previous Pet #3 Age*
204. Previous Pet #3 Gender*

     1. Male
     2. Female
205. Was Previous Pet #3 Spayed/Neutered?*

     1. Yes
     2. No
206. Was Previous Pet #3 An Indoor Or Outdoor Pet?*

     1. Indoor
     2. Outdoor
208. Have You Previously Owned Another Pet?*

     1. Yes

     1. No
210. Previous Pet #4 Name*
211. Previous Pet #4 Species*
212. Previous Pet #4 Breed*
213. Previous Pet #4 Age*
215. Previous Pet #4 Gender*

     1. Male
     2. Female
216. Was Previous Pet #4 Spayed/Neutered?*

     1. Yes
     2. No
217. Was Previous Pet #4 An Indoor Or Outdoor Pet?*

     1. Indoor
     2. Outdoor
219. Have Your Previously Owned Another Pet?*

     1. Yes

     1. No
221. Previous Pet #5 Name*
222. Previous Pet #5 Species*
223. Previous Pet #5 Breed*
224. Previous Pet #5 Age*
226. Previous Pet #5 Gender*

     1. Male
     2. Female
227. Was Previous Pet #5 Spayed/Neutered?*

     1. Yes
     2. No
228. Was Previous Pet #5 An Indoor Or Outdoor Pet?*

     1. Indoor
     2. Outdoor
230. Have You Previously Had Any Other Pets That Are Not Listed Above?*

     1. Yes

     1. No
232. Shelter Staff Will Ask For Information About Any Other Previous Pets Not Listed Above When You Are Called For A Phone Interview.*

     1. I Understand & Agree
234. Household Information
236. Do you plan on moving the next one year?*

     1. Yes

     1. No
238. If yes, when do you plan on moving?*
240. Which Option Best Describes Your Home?

     1. House
     2. Apartment

     1. Mobile Home
     2. Townhouse/Condominium
241. Do You Own Or Rent?*

     1. Own
     2. Rent
243. Landlord/Apartment Complex Name*
244. Landlord/Apartment Complex Phone Number*
246. Mobile Home Park Name*
247. Mobile Home Park Office Phone Number*
249. HOA Association Name*
250. HOA Association Phone Number*
252. Please Tell Us The Number Of Individuals In Your Household*
253. Are Any Of Your Household Members Children?*

     1. Yes
     2. No
254. Please Tell Us The Ages Of All Children In Your Household*
256. Do have children that visit often?*

     1. Yes

     1. No
257. Please List The Ages Of The Children Who Visit Often*
259. Do All Of The Adults In Your Household Consent To The Adoption Of A Pet?*

     1. Yes

     1. No
261. Does Anyone In Your Household Have A Known Pet Allergy?*

     1. Yes

     1. No
263. Disclosures, Notices & Consents
265. The Porter County Animal Shelter will not adopt "bully breed" dogs to: Gary, Merrillville, Hammond, East Chicago, Whiting Indiana or other areas that have proven inhospitable for our animals. *

     1. I Understand & Agree
267. I Am Age 21 Or Older*

     1. I Understand & Agree
269. I Have & Will Be Required To Provide Identification Showing Proof Of Current Address*

     1. I Understand & Agree
271. Porter County Animal Shelter Reserves The Right To Refuse Adoption To Any Person For Any Reason.*

     1. I Understand & Agree
273. Adoption Approval Or Refusal Decisions Are Made Solely At The Discretion Of The Porter County Animal Shelter.*

     1. I Understand & Agree
275. Falsifying Information On This Adoption Application Will Result In Disqualification From Adoption.*

     1. I Understand & Agree
277. All Adoption Applicant's Homes May Be Screened For Suitable Placement Of Animals.*

     1. I Understand & Agree
279. By Providing Your Electronic Signature Below, You Give Permission For The Porter County Animal Shelter To Investigate And Confirm The Information Provided. You Further Agree that This Information Can Be Shared With Other Humane Societies Or Rescue Groups.*

     1. I Understand & Agree
281. By Providing Your Electronic Signature Below, You Hereby Give Permission To May Landlord, Apartment Complex, Mobile Home Park, Homeowner's Association or Neighborhood Association To Release Information To The Porter County Animal Shelter Concerning My Pet Deposit Or Any Other Rules Regarding Pet Ownership.*

     1. I Understand & Agree
283. By Providing Your Electronic Signature Below, You Hereby Give Permission For Any Veterinarian Providing Service To Me To Release All Medical Information On Any/All Of My Animals, Past & Present, To Porter County Animal Shelter.*

     1. I Understand & Agree
285. By Providing Your Electronic Signature Below, You Affirm That The Information Provided In This Online Adoption Application Is True & Correct And Agree To The Requirements Of The Porter County Animal Shelter's Adoption Process.*

     1. I Understand & Agree
287. Electronic Signature*
     Please Type In Your Full Legal Name.
288. Date Electronically Signed*
     Date Electronically Signed
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