Pet Adoption Application

Above the Notch Humane Society
ATTN: Adoption Coordinator
PO Box 456
Littleton, NH 03561

* Animal

* Name

* Spouse

* Physical Address

* Mailing Address

* City

Select a State

* Zip Code

* Email

* Home Phone

* Cell Phone

* Over 21 Years Old?

* Number of Children

* Ages

* How Many People Reside in Your Home?

* Is Anyone Allergic to Animals?

Landlord Name & Phone

* How Long Have You Been At This Residence?

* Employer Name

* Employer Address

* Employer Phone

* How Many Years at Job?

* How Many Hours Daily Are You Away From Home?

* Where Will The Pet Be While You Are Away From Home?

* Veterinarian

* Veterinarian Address

* Veterinarian Phone

* Why Do You Want To Adopt This Pet?

* Other Pets You Own or Have Owned In The Last 5 Years

* Personal Reference #1

* Personal Reference #2