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Adoption Application

Completion of this application does not guarantee placement of an animal with the applicant. PMHS animals are assessed for placement with the home that best fits the animal’s needs.

Application Type
- Dog
- Puppy
- Cat
- Kitten
- Small Animal
- Barn Cat/Mouser - Strictly Outdoor
Name of Specific Animal (If Applicable)
Adopter Information
Applicant's Name*
First Last
Date of Birth*
Month
Day
Year
Co-Applicant's Name (optional)
First Last
Co-Applicant's Date of Birth
Month
Day
Year
Address (Physical)*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Mailing Address (if different from above)
Street Address Address Line 2 City State ZIP Code
US Military Status
- Active
- Discharged
- Retired
How many children (under 18) live in the home/visit often? What are their ages?*
How many adults (over 18) live in the home?*
Does anyone in the household have any allergies to animals?*
Current Living Arrangements*
- I own my own home
- Live with home owner
- Rent: Apartment, House, Condo, Duplex, Mobile Home, Dorm
Type*
- House on Land
- Mobile Home on Land
- Mobile Home in Park
- Condo/Townhouse
- Duplex
Type of Rental*
- Apartment in Complex
- Apartment attached to a House
- Condo/Townhouse
- House on Land
- Mobile Home on Land
- Mobile Home in Park
- Duplex
Name of Establishment*

Such as the Co-Op, Park, or Complex name(i.e. Glenwood Estates)
Name of Homeowner*
First Last
Homeowner's Phone*
Name of Landlord*
First Last
Landlord's Phone*
Pet History
Please list all the pets that you currently own, have owned, or have/had living with you in the past THREE years.
Do you currently own/have owned a pet/or have/had a pet(s) living with you within the last three years?*
- Yes
- No
Pet #1 Name*
Pet #1 Breed/Type*
Pet #1 Age*
Pet #1 Sex*
- Male, Intact
- Male, Neutered
- Female, Intact
- Female, Spayed
Where is/was this pet kept?*
Do you still own this pet?*
- Yes
- No
If no, what happened to this pet?*
Do you have another pet to add?*
- Yes
- No
Pet #2 Name*
Pet #2 Breed/Type*
Pet #2 Age*
Pet #2 Sex*
- Male, Intact
- Male, Neutered
- Female, Intact
- Female, Spayed
Where is/was this pet kept?*
Do you still own this pet?*
- Yes
- No
If no, what happened to this pet?*
Do you have another pet to add?*
- Yes
- No
Pet #3 Name
Pet #3 Breed/Type
Pet #3 Age
Pet #3 Sex
- Male, Intact
- Male, Neutered
- Female, Intact
- Female, Spayed
Where is/was this pet kept?
Do you still own this pet?
- Yes
- No
If no, what happened to this pet?
Do you have another pet to add?
- Yes
- No
In the box below please provide all information on any additional pets:
What is the name of your current or past veterinarian or clinic?*
Have you ever brought an animal to an animal shelter?*
- Yes
- No
If yes, why?*
Where will this animal be housed?*
Who will be the primary caregiver for this animal?*
What type of cat are you looking for?*
- Indoor only
- Indoor/Outdoor
- Mouser
- Barn cat
Do you plan on declawing your cat?*
- Yes
- No
Why would you like to adopt this dog?*
Who are you adopting this dog for?*
Certification Statement*
- I certify that I am at least 21 years of age and that all information given is true. I authorize PMHS to contact veterinarian(s) and landlord(s) to investigate all statements in this application and to do follow-up property checks. I have read and understand the PMHS Adoption process. I understand that by completing this form PMHS has the right to deny my request to adopt.
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Contact Us

Pope Memorial Humane Society
221 County Farm Road,
Dover, NH 03820

(603) 749-5322

[email protected]

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Hours

PMHS Adoption Center:
Sunday – Saturday: By Appointment Only
Effective 12/28/21

PMHS Administrative Office hours:
By appointment only.

Animal Surrenders:
By appointment only. Please refer to the Programs & Resources page.

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