Notice: Undefined index: pet in /home/rchs/randolphhumane.org/pre-adopt-form-pet.php on line 23 Pre-Adoption Questionnaire | Randolph County Humane Society | Sparta IL 62286

QUICK LINKS >>

 

Phone & Fax

phone:
618.443.3363

fax:
618.282.1749


Mailing Address

Randolph County Humane Society
P.O. Box 59
414 W. Belmont Street
Sparta, Illinois 62286


Visit Us

We are located in the BIG White building with the Blue Tinted Roof at the Sparta Fair Grounds, just behind the Lion's Club at:
414 W. Belmont Street, Sparta, Illinois 62286


Shelter Hours

MONDAY - FRIDAY
9:00am - 1:00pm (Approx)
Evenings by Appointment PLEASE
Weekends by appointment ONLY
Closed Holidays (Except our Care & Cleaning Crew)
PLEASE leave a message, we check them everyday, 2-3 times daily and all calls are returned.
*Our hours may vary. Please call and a volunteer, we will be happy to assist you, please understand we are a small group that give our own time and money to the RCHS, and sometimes our own lives and families get pushed to the back burner and suffer, please understand when we don't get right back in touch with you at that same moment it may take 24 hours to get a call back, but we will call you back.
FOR EMERGENCY CALL THE POLICE DEPT, and they will contact animal control or someone with the RCHS to assist you.


Support Us Today!

If you are interested in supporting RCHS and would like to contribute, you are welcome to make a small donation through the donate link on our website - it will help more than you could imagine.

Pet Adoptions


Pre-Adoption Questionnaire
Adopting a pet can be an 18 year commitment. Please take a few moments to carefully respond to these questions, so that we may be sure that this placement is in the best interest of both you and the pet. (all fields required) » view printable questionnaire
   (pet's name and ID)
REGARDING:
   
full name:
email:
   
address:
city:
state:
zip code:
phone:  (area code)
2nd phone:  (area code)
   
Your Age:
What valid Photo ID will you present?
Driver's Lic or ID#
Have you ever been convicted of a Felony?
Please Select Your Residence Status:
* If you rent, please provide Landlord's:
name:  phone:
* If you live with a relative, please provide Relative’s:
name:  phone:
Will you be moving soon?
What are your plans for this pet?
Does your job require frequent relocation?
If so, what are your plans for this pet?
What pets currently live with you?
Where do they spend most of their time?
How are they confined? What shelter do they have?
How many pets have you owned in the last 5 years?
What happened to them?
Do you have a Veterinarian?
If Yes, please provide your Veterinarian's information below:
name:      phone:
address:
city:        state:  zip:

Why do you want to adopt this pet?
Is this pet a gift?
If yes, for whom?
Do you plan to have this pet spayed or neutered?
Do you plan to allow this pet to breed?
How much time will this pet spend alone?
Is anyone in your home allergic to animals?
Do you have children living with you?
If Yes, Please list their ages.
Who will care for this pet in your absence (vacations, etc.)
All pets require housekeeping and training to permit adjustments to a new family and to correct problem behavior.
Are you prepared to housebreak and train this pet?
Will you require additional info?
Information regarding the health and behavior of adopted animals may not be available or accurate.
What behavior would you be unwilling to work with?
Are you aware that all vaccinations and veterinary care after adoption are at your expense?
Do you understand that NO REFUNDS are issued if the animal is returned?

STRAYS ONLY: I understand that no information is available about the prior history, behavior or temperament of this pet. I am willing to provide any needed training and supervision.
( Please Initial )
   
CONCLUSION: When adopting a pet, you are making a commitment to care for this animal for the rest of it’s life. Please consider your future plans such as moving or having a family before taking on the legal, financial and moral responsibilities of owning a pet. If no adoption takes place within the time allowed after completing this questionnaire, you will be required to fill out another questionnaire if/when you return in the future.
 
* BY SUBMITTING THIS QUESTIONNAIRE YOU AGREE THAT (1) THE ABOVE INFORMATION PROVIDED BY YOU IS ACCURATE AND HONEST. (2) YOU READ, UNDERSTAND AND ACCEPT THE TERMS OUTLINED UNDER "CONCLUSION"