ADOPTION APPLICATION

*Required fields

Date: Sunday, May 20, 2012

Full Name: *

House / Building / Apartment Number: *

Contact Numbers:
#1 *  #2

1. What type of animal are you interested in adopting?*
Dog  Cat  Other

Animal Name (if known or chosen already):

2. How long have you lived at the above address:  *

3. Do you rent or own?  Rent  Own Home

4. If you are renting please answer the following:

Landlord: 
Contact #: 

5. Who lives at this address?*

6.  If there are any children living there what are their ages?

7. Does anyone who lives at this address have any animal allergies?
Yes  No

8. What is the reason(s) for adopting the animal?

9. Who will be the caregiver for this animal?  *

10. Are you planning on moving in the future?  Yes  No

If Yes will your pet be going with you?
Yes  No

11. If you go out of town will you take your pet with you or will the pet stay at home?
Will travel with us  Will stay in Iqaluit

12. If your pet stays who will take care of them? (Please include contact information)

13. Will the animal be indoors or outdoors?  Indoors  Outdoors

14. Have you ever surrendered an animal to the Iqaluit Humane Society?
Yes  No

If Yes please explain:

15. Have you ever had an animal picked up by the By-law
Yes  No

If Yes please explain:

16. Do you have any other animals living at your home?
Yes  No

If Yes what are they and how old?

17. Are your pets spayed or neutered?  Yes  No

18. Will you be getting your new pet spayed or neutered?
Yes  No
*Spayed means removal of female reproductive organs (ovaries).
*Neutered means removal of male reproductive organs (testicles)

If your vet is located outside of Iqaluit, NU proof of spay or neuter must be provided upon return to Iqaluit.

**All animals adopted from the Iqaluit Humane Society must have the spay/neuter procedure done on the next veterinarian visit to Iqaluit. Please read the Spay and Neuter agreement below that must be signed and agreed to as a condition of adoption.**

19. Would you be willing to let the IHS do visits to your home to check up on how the animal is doing?  Yes  No

20. If you checked No to question 19 please state a reason why?

Adoption & Spay / Neuter Agreement

This Agreement must be electronically signed before the release of any animal.  Failure to do so would result in the cancellation of your adoption application.

I hereby state that all information in this application is true and to the best of my knowledge. I understand that my application can be turned down if otherwise. I understand that the process of adoption is not based on first come for an animal but is based on who will be a better caregiver for the animal. I also agree that by submitting this web form application I am electronically signing my name to this document and am bound by the conditions and terms contained therein.

I agree to have the above pet altered at the next veteranarian visit in Iqaluit, NU.  I acknowledge that I will prepay for the cost of this procedure with the Iqaluit Humane Society 2007 Inc prior to taking my new pet home. I understand that the Adoption Committee will book an appointment for my new pet and contact me with the details. I understand that I am responsible in making sure that I do not miss this appointment.  If I do not show up for my appointment I understand that theIqaluit Humane Society 2007 Inc will repossess my animal and the fees paid will not be refunded.

I understand that by voluntarily signing this agreement, I am entering into a legal and binding contract with the Iqaluit Humane Society 2007 Inc.  In the event that there is a violation of the agreement, I understand that the Iqaluit Humane Society 2007 Inc will contact the Bylaw to enter onto my premise and retrieve the animal stated above.  The animal will then be returned to the Iqaluit Humane Society 2007 Inc. I also understand that I will not be able to get the animal back and that this may hinder ever adopting an animal from the Iqaluit Humane Society 2007 Inc in the future. 

I certify that I have read and understand the terms of this Spay/Neuter Agreement.  I acknowledge that failure to comply with these terms shall be a breach of contract and shall result in the immediate return of the adopted pet to the Iqaluit Humane Society 2007 Inc.

This application will have a 48 hour waiting time. You will then be contacted by the IHS and informed of the decision.