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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
Name of Specific Animal (If Applicable)
Adopter Information
Name*
First Last
Date of Birth*
MM
DD
YYYY
Spouse/Partner's Name
First Last
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: House, Condo, Duplex, Mobile/land, Mobile in Park
- Live with home owner
- Rent: Apartment, House, Condo, Duplex, Mobile Home, Dorm
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 or have owned in the past three years.
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.
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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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Email*

Hours

PMHS Adoption Center:
Adoptions are currently by appointment only. Casual visits are restricted.

PMHS Administrative Office hours:
By appointment only.

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

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