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  • Adoption Application

     

     INLAND VALLEY HUMANE SOCIETY AND SPCA

    "Companion for Life" Adoption Application

    You are required to complete this application prior to adopting an animal from Inland Valley Humane Society and SPCA
    (“IVHS”). If you adopt an animal from IVHS, this application becomes part of the adoption contract. Your signature at
    the end of this document indicates that you have read the document and have provided truthful responses. Please note
    that if you provide information on this application that is untrue, IVHS reserves the right to permanently disqualify you
    from adopting animals from IVHS. If you misrepresent yourself as an individual and are actually representing or the
    owner of an animal rescue organization, IVHS will permanently disqualify you from adopting animals from IVHS.

    To qualify for adoption, you must:
    · Be at least 18 years old and have a valid driver’s license or state identification card stating your current
    address
    · Have the knowledge and consent of a landlord, if relevant
    · Be able and willing to spend the time and money necessary to provide medical treatment, proper
    nourishment and care, and training for a pet
    1.  


    2. APPLICANT INFORMATION:

    *

    Name:

     

     

       

    *

    *

     

     


    *3.  


    *4.  


    5.

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

    6.

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

    *7.  


    *8.

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

    *9.
    Question - Required - Residence Type:

    *10.


    *11.


    *12.


    13.

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

    14.

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

    15.  


    16.


    17.

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

    18.


    19.

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

    *20.


    21.

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

    *22.


    23.

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

    *24.  


    *25.


    *26.


    27.

    *28.


    *29.


    *30.


    31.  


    *32.


    *33.


    *34.


    *35.

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

    *36.

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

    *37.

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

    *38.

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

    *39.

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

    *40.
    Question - Required - Date:




     

    THE FOLLOWING SECTION IS TO BE COMPLETED BY IVHS:

    41.


    42.
    Question - Not Required - Date:




    43.


    44.
    Question - Not Required - Date:




    45.

    46.

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

    47.

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

    48.  


    49.

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

    50.


    51.

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

    52.


    53.
    Question - Not Required - Date:




    54.


    55.
    Question - Not Required - Date:




    56.


     

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

       Please leave this field empty