BCHS Online Application

Get pre-approved before your visit to adopt an animal. (To ensure a speedy approval please fill out as completely as possible)

Click here for a printable version.

Who are you interrested in (leave blank if unsure)
Why do you want to adopt a pet?
Full Name Telephone
Street Address
City
State
Zip
Do You Own Rent Other
If you rent please list your Landlord's
Name
Telephone
Please list all persons beside you residing at your home
 Name
Age
Relationship
Please list all your current pets
Dog or Cat
Age
Sex
Spay/Neutered
 Kept inside?
If you do not have pets currently, how many pets have you owned in the past 5 years?
What happened to them?
Who is your veterinarian?
Telephone
May we contact them?
What is the longest period your pet will be alone?
Where will the pet be kept when alone?
Where will the pet spend it's days nights
Who will be the primary caregiver to your new pet?
Have you discussed adopting a pet with all members of your household?
Does everybody in your household want a pet?
Do you or anyone in your household have pet allergies?
Are you willing to spend the necessary time to housetrain your pet?
If a behavioral problem arises, what steps will you take to work it out?
How much do you expect to veterinary care and food to cost monthly?
Do you understand that adopting a pet is a lifelong commitment and should be discussed with thoroughly with all members of your household?
If you moved and were not allowed pets, what would you do?
Do you understand the animal may not be given away or sold and if you must part with the animal, it must be returned to the Bedford County Humane Society at a fee of $20 after 30 days?
Have you or anyone in your household ever been cited by a Humane Officer or Dog Law Officer?
If yes, Please explain:
Are you aware of state laws pertaining to pet licensing and vaccinating?
Do you understand that by State Law any pet adopted from a Humane Society must be spayed or neutered and documentation provided to the shelter?
Please list two references that are not relatives
Name Address Telephone
I certify that all of the above information is true and correct and give my permission to contact any person listed on this application

Bedford County Humane Society 1108 Lutzville Road, Everett, PA 15537 814.623.8968