Adoption Application

HSIC dogs and cats are listed as available until their adoption is finalized.
We do not hold dogs or cats for potential adopters, and we may consider multiple applications for each dog or cat.
Submitting an application does not guarantee approval to adopt.

Please use the following format 870-555-5555.
Please use the following format 870-555-5555.
Please use the following format 870-555-5555.
Please enter correctly as this is the main way we will contact you.
If you have never owned a pet please tell us where you would go.
Again if you have never owned a pet please list where you would go
Personal References (Please, no immediate family member or current household resident. HSIC does contact references, so you references should be told to expect a call from a HSIC representative.

By typing my full name, I affirm that:
- I understand that this is a legal document. I am 21 years of age or over and the information contained on this form is true to the best of my knowledge. I make this statement under penalty of perjury under the laws of the state of Arkansas. I understand that providing false information will result in the agreement being denied or revoked and that I may be prosecuted. I understand that HSIC reserves the right to deny an application for any reason.
- I give permission to Humane Society of Independence County to verify any of the information given, which includes contacting personal references and veterinarian.
- I grant permission to Humane Society of Independence County for a Shelter representative to visit my home before my adoption application is approved, as well at any time after adoption.
- It is my intention to integrate this animal into my home and life as a pet, companion, and family member.
- I understand that the adoption of any pet is a commitment to provide food, water, love, shelter, and care for the duration of the pet's life.
- If for any unforeseen, unavoidable reason you are unable to keep your cat or dog in the future, we ask that you return it to HSIC.
- ALL FEES ARE NON-REFUNDABLE. If you are unable to keep the animal you adopt, you may exchange one time for another if it is returned within 30 days. However, we have the right to decline any exchange. If you decide not to adopt, any fees will be applied as a donation to The Humane Society of Independence County.
- I am prepared and able to be financially responsible for veterinary care, including but not limited to annual checkups, vaccinations, and heartworm preventative. As a responsible pet owner, I understand that it is my responsibility to have my newly adopted pet thoroughly examined by my own veterinarian no later than 72 hours after adoption.
- I understand that it is an Arkansas State law that I must have my pet vaccinated against rabies each year.
- I hereby hold harmless the Humane Society of Independence County, any employee, volunteer, and/or person associated with HSIC from any liability, injury, or damage to persons or property caused by this adopted pet. I also hold harmless the above-named from any claim, action, suit, or demands which may arise as a result of this adoption.