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  • Adoption Application

     

     

    The Inland Valley Humane Society & SPCA

    "Companion for Life" Adoption Application

    Thank you so much to those who could open their homes to a pet in need. Your compassion and kindness is truly appreciated. Please include your name, address, phone number and several control numbers of the pets you think might be a match for you.

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    2. APPLICANT INFORMATION:

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    Name:

     

     

       

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    City/State/ZIP:

     

        

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    Date of Birth:

     

     


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    (Maximum response 255 chars, approx. 5 rows of text)

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    (Maximum response 255 chars, approx. 5 rows of text)

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    (Maximum response 255 chars, approx. 5 rows of text)

    *9.
    Question - Required - Residence Type:

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    (Maximum response 255 chars, approx. 5 rows of text)

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    (Maximum response 255 chars, approx. 5 rows of text)

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    (Maximum response 255 chars, approx. 5 rows of text)

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    (Maximum response 255 chars, approx. 5 rows of text)

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    (Maximum response 255 chars, approx. 5 rows of text)

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    (Maximum response 255 chars, approx. 5 rows of text)

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    (Maximum response 255 chars, approx. 5 rows of text)

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    (Maximum response 255 chars, approx. 5 rows of text)

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    (Maximum response 255 chars, approx. 5 rows of text)

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    (Maximum response 255 chars, approx. 5 rows of text)

    *39.
    Question - Required - Date:




     

    THE FOLLOWING SECTION IS TO BE COMPLETED BY IVHS:

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    41.
    Question - Not Required - Date:




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    Question - Not Required - Date:




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    (Maximum response 255 chars, approx. 5 rows of text)

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    (Maximum response 255 chars, approx. 5 rows of text)

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    (Maximum response 255 chars, approx. 5 rows of text)

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    (Maximum response 255 chars, approx. 5 rows of text)

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    Question - Not Required - Date:




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    Question - Not Required - Date:




    55.


     

    If yes, certification must be provided at time of adoption. 

       Please leave this field empty