Indiana County Humane Society
191 Airport Road,Indiana, PA 15701
Phone: (724) 465-7387Fax: (724) 465-6871
Shelter Manager: sheltermanager@incohumanesociety.comGeneral Information: questions@incohumanesociety.com
Fields marked with * are required.
Please note: Animals cannot be held. Adoptions are first-come, first-served pending application approval and the ICHS Staff Adoption Counselor's recommendations. ICHS reserves the right to deny any application.
Which animal(s) are you interested in adopting? *
Animal type * DogCat
Is this your first experience with a pet? * YesNo
If no, what happened to the pet(s) you no longer have?
Have you ever adopted from ICHS? * YesNo
If yes, when?
Have you adopted from another shelter? * YesNo
If yes, when? Name of shelter
Have you ever surrendered an animal to a shelter? * YesNo
If yes, name of shelter
When? Why?
Under what circumstances would you not keep a pet? *
Where will the pet be kept during the day? * At night? *
How many hours per day will the pet spend alone without human companionship? * Where will the pet be kept when you're not home? *
Dog adopters: What type of outside space is available? Fenced yardKennelUnfenced yardPatioRunTie-Out
Do you own, rent, or lease space in a mobile home park? * OwnRentLease space in a mobile home park
Time at current address? * Landlord's name and phone number, if applicable
Name * Phone *
Email * Address *
City * State * ZIP *
County * Township/Borough *
Occupation * Employer *
Include yourself and list each person's age, relationship, and allergies, if any.
Name * Age *
Relationship * Allergies, if any
Name Age
Relationship Allergies, if any
Reference 1 name * Phone *
Reference 2 name * Phone *
What pets do you currently have in your household? Please list.
Pet 1 name
Type DogCatOther
If other Age
Spayed/Neutered? YesNo
Pet 2 name
Pet 3 name
Pet 4 name
If you have or have had pets, who is your veterinarian? List recent veterinarians used, current first.
Veterinarian 1 name Phone
Veterinarian 2 name Phone
Under what first and last name is your pet(s) registered at the veterinarian's office?
I certify that all information supplied on this application is true and correct. I understand the ICHS reserves the right to refuse adoption to anyone. I am at least 21 years of age. I hereby give ICHS permission to contact anyone named on this application. By checking the certification below, I confirm that I agree and understand that the ICHS is not responsible for any illness, property or personal damage caused by a shelter animal.
I agree to the certification above and confirm that I am at least 21 years old. Application date *