Blue Mountain Humane Association Adoption Application
      The Blue Mountain Humane Association is a non-profit
organization committed to all animals in our care and consider
pet ownership a serious responsibility.
In order to be considered as an adopter, you must:
      (1) be 18 years of age or older, (2) have identification showing proof of name and age,
      (3) have the knowledge and consent of your landload if you are renting, 4) be able and
      willing to spend the time and money necessary to provide training, medical treatment,
      and proper care for a pet.
          Our adoption fee covers the pet’s first shot, deworming, and a complimentary examination by a La Grande veterinarian of your choice. If the pet is not spayed or neutered you will be sold a voucher, which is mandatory, that may redeem at your veterinarian’s office when you get the animal sterilized.

      The following information is requested so that your adoption counselor can assist you in the selection of a new pet. The animal’s welfare is our foremost consideration. The consutation process is designed to help us determine if the adoption is in the animal’s best interest, and to assist you in finding a pet most compatible with your lifestyle. We will ask for your cooperation throughout this process of bringing people and animals together. Note! No animal will be adopted to prospective owners who mislead or fail to provide accurate information on the adoption application.
      name _______________________________________________

      address______________________________________________

      city _____________________ state ________ zip ____________

      home phone _____________ work/message phone ______________

      birth date ___________ driver’s license no. ____________________

What kind of pet are you wishing to adopt? ___ kitten, ___ cat, ___ puppy, ___ dog, ___ other

      specific type and breed of pet desired _________________________________

Where will the pet be located? ___ house, ___ duplex, ___ apartment, ___other

      Do you: ___ own, ___rent, ___live with relatives?

      Number of people in residence _____. Ages of children there ___, ___, ___, ___.

      If renting, name/phone no. of landlord required: _______________________________

       How long have you lived at this address? ____ Do you plan to move soon? ___ yes, ___ no.

       If you move, what will you do with this animal? ________________________________

Who are you adopting this pet for: ___ self, ___child, ___ relative, ___ friend, ___ other.

      Are they aware you are adopting this pet for them? ___ yes, ___ no

       May we contact them? ___ yes, ___ no. Contact number ____________________

Why do you want a pet? ___ house pet, ___ personal companion, ___ company for another pet,
      ___ watch dog, ___ guard dog, ___mouser, ___ breeder, other: ___________
      Do you or anyone living in your residence have any known allergies to animals? ___ yes, ___ no.

      If yes, please explain ________________________________________________

Is this your first experience with a pet? ___ yes, ___ no.

      Where will the pet be kept during the day? _________________________________

      Where will the pet be kept when alone? ___________________________________

      How many hours will it spend alone without human companionship? _______

      Do you realize you will probably have to house train your new pet? ___ yes, ___ no.

      Would you like information on house training your dog, or litterbox tips for cats? ___ yes, ___ no.

Do you plan to have your pet spayed or neutered? ___ yes. ___ no.
       Why? _______________________________________________
    Will the pet be: ___ indoor only, ___ outdoor only, ___ inside/outside, ___ haven’t decided.

    How do you plan to confine your pet? ___ inside, ___ fenced enclosure, ___ pen, ___ kennel,

    ___ chain, ___ honor system, ___ none (please explain) ________________________
    The animals available for adoption were examined upon entry, and their health routinely monitored while at the shelter, but there is always a chance that an animal is incubating a disease without showing any clinical signs as they have come from a variety of sources.
    Are you aware of the medical costs associated with pet guardianship? ___ yes, ___ no.
          How much do you expect to spend yearly on your pet
               ___ $50-$100, ___ $100-$300, ___$300-$600, ___ $600+.
Do you have a veterinarian? ___ yes, ___ no.
    We can not recommend a veterinarian; however, would you like a local listing? ___ yes, ___ no.
Do you know the leash and licensing laws in your community? ___ yes, ___no.

       Do your neighbors own livestock, farm, or exotic animals? ___ yes, ___ no.

         How will you handle unacceptable behavior by your pet? ___________________

         Do you plan to take your dog to obedience training classes? ___ yes, ___ no.

         Would you like information about local obedience classes? ___ yes, ___ no.

List all pets currently in your household or owned in the past five years . . . . .
        The Animal Shelter Staff reserves the right to refuse adoption to anyone for any reason. No animal will be adopted to persons having an extensive history of losing, giving away, selling, or having animals injured or killed by motor vehicles. It is BMHA policy that all animals will be sterilized before leaving the Shelter.

        In some cases an on-premise inspection by an Animal Control Officer or Humane Society representative may be necessary before the adoption process can be completed.

        I certify that all of the above information I have provided is true. I understand that the Blue Mountain Humane Association reserves the right to refuse any adoption, and this application remains property of BMHA.

Applicant’s signature _________________________________ date ___________________

How did you hear about our adoption service? __________________________
For BMHA Use Only

Diver’s License Number: ___________________

Date of Birth ___________________         Reason for adoption denial:

Landlord Approval ___ yes ___ no

Background check complete ___ yes ___ no

Adoption Approved ___ yes ___ no

Restrictions _____________________ _______ Staff initials completing adoption __________

form 3-2-2004 jg