Online Application

Submitting your application does not guarentee the dog of your choice.
Please visit our Adoption Process Page if you have any questions.

HCAS Adoption Application

Adress:     City:   State:   Zip:
E-mail:    Phone: 
Animal Applying For:    Breed: 

Are there any other animals in the home?   Yes:  No:
If Yes:
How many?      Are they altered?   Yes:  No:    Are Vaccinations up to date?  Yes:  No:
If you don't have any pets, have you owned any before?   Yes:  No:
If yes, what happened to the pets?  
Have you ever surrendered a pet?  Yes:  No:
Do you have any experience with this breed?  Yes:  No:     If not, have you researched it or are you willing to?  Yes:  No:
Are there any children in the home?   Yes:  No:    If so, how many?    Ages: 
Do you rent or own your home?   
If you rent, proof from your landlord will be required and verified before adoption is approved.

Are you employed?  Yes:  No:   Occupation: 
Who is your veterarian?   Location:   Phone: 
If approved for adoption do agree to take your pet to the veterinarian for any follow up care and routine checkups? Yes:  No:
Please list two non family references:
Reference:   Phone: 
Reference:   Phone: 

Please Read and Acknowledge the following:

Holt County Animal Shelter Policies:

Responsible party must be over 21 or have parental consent.
Adoption applications can be submitted to any board member and will be approved/denied by all four members in a timely manner.
All animals will be given physical exam, temperament tested, spayed or neutered, and vaccinated and micro-chipped prior to adoption unless       there are extenuating circumstances.
It is recommended to keep the adopted dog isolated from other pets in the home for 5 days after arrival.
New owners agree to take the pet to their veterinarian for any required booster vaccination or other medical care.
New owners agree to comply with local laws regarding licensing, vaccination, off leash activities, etc.
New owner agrees to provide adequate food, shelter and confinement. (not allowed to roam free)
HCAS will not be responsible for costs of medical care for the adoptive pet once it is in its new home.
It is recommended to allow the new pet to meet any current pets prior to finalizing the adoption.
The adoption fee covers medical and housing expenses prior to adoption, including any vaccinations and spay or neuter and micro-chip. It is       non-refundable; however HCAS will waive the intake fee if the pet is returned within 60 days of adoption.

Please allow a couple of days for someone to get in touch with you!