The Humane Society of Harford County
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Uniting pets and people since 1946
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YOUR INFORMATION
Name
First
Last
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
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Egypt
El Salvador
Equatorial Guinea
Eritrea
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Eswatini
Ethiopia
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Faroe Islands
Fiji
Finland
France
French Guiana
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Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
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Greenland
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Guadeloupe
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Guinea-Bissau
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Korea, Republic of
Kuwait
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Latvia
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Liberia
Libya
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Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
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United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Phone
Email
PET INFORMATION
We thank you for completing this form with as much detail as possible so we can make every effort possible to place your pet with an appropriate adopter, foster or rescue group.
Pet's Name
Breed
Sex
Male (Not Neutered)
Female (Not Spayed)
Neutered Male
Spayed Female
Declawed? (pertains to cats only)
Front Only
Rear Only
All Four Paws
Not Declawed
Current Age
Date of Birth (if known)
MM slash DD slash YYYY
HISTORY
How old was your pet when you obtained him/her?
How did you get your pet?
Found/Stray
Previous Owner
Breeder
Bred at home
Shelter
Rescue Group
Pet Store
Internet
If you answered Shelter, Rescue, Pet Store or Internet above, please tell us which one.
HEALTH
When was your pet's last visit to the veterinarian?
Veterinarian's Name
Veterinarian's Phone
Veterinarian's Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Do we have permission to contact your veterinarian to obtain your pet's vaccine status and medical history?
Yes, I allow HSHC to contact my veterinarian
Does your pet have any medical problems? (check all that apply)
Allergies
Arthritis
Conjunctivitis
Coughing
Diabetes
Diarrhea
Hearing Loss
Heart Murmur
Organ Failure
Seizures
Skin Issue
Tumor(s)
Vision Loss
Vomiting
Please provide as much detail as possible about any of the medical problems checked above. Be specific about duration of problem, frequency, symptoms, treatments given, etc.
Is your pet currently taking any medication(s)?
Yes (see next question)
No (skip next question)
If you answered yes above, please list all medications, strengths, and dosages:
Do you treat your pet with flea, tick, or heartworm prevention?
Yes (see next question)
No (skip next question)
If yes, please list the type of prevention(s) and the last time it was administered:
HABITS & PERSONALITY
Where does your pet spend the day?
Inside, Unconfined
Inside, Confined to a Room
Inside, Confined to a Crate
Inside with access to outside (doggie door)
Outside, Unconfined
Outside, in Fenced Yard
Outside, on Rope or Chain Lead
Garage or Basement
In Barn or Shed
Doggie Daycare
At Work with Owner
Where does your pet spend the night?
Inside, Unconfined
Inside, Confined to a Room
Inside, Confined to a Crate
Inside with access to outside (doggie door)
Outside, Unconfined
Outside, in Fenced Yard
Outside, on Rope or Chain Lead
Garage or Basement
In Barn or Shed
In Room, with Owner
In Bed, with Owner
How would you describe your pet's personality? (check all that apply)
Active
Curious
Laid-back
Lap loving
Loner
Playful
Shy
Fearful
What are your pet's favorite activities? (check all that apply)
Climbing
Cuddling
Digging
Fetching
Playing
Quiet time
Running
Sleeping
Swimming
Walking
What brand of food does your pet eat?
What type of food does your pet eat?
Wet (canned)
Dry kibble
Both
How much food does your pet eat per meal?
How many times a day does your pet eat?
Is your pet afraid of anything like thunder, loud noises, vacuum cleaner, etc.?
What does your pet do when frightened?
Has your pet ever demonstrated any undesirable behaviors? (check all that apply)
Baring teeth
Biting or mouthing
Destructive chewing/scratching/digging
Excessive barking
Food protection/aggression
Lunging
Nipping
Scratching people
Scratching rugs or furniture
Snapping
Toy protection/aggression
My pet exhibits these behaviors...
Always
Only when alone
Only when people are home
Combination of above
Has your pet ever bitten a person or another animal?
Yes
No
If yes, please describe the circumstances surrounding the bite and severity of the bite in detail:
IDEAL HOME
Please describe your pet's exposure to children
Lived with children
Regularly visited by children
Infrequent contact with children
No experience with children
What ages are/were the children your pet came in contact with?
Describe any positive or negative interactions your pet has had with children:
Would you recommend placing your pet in a home with children?
Yes, children of any age
Yes, but only with children older than 12
No
Please describe your pet's experience with dogs:
Has lived with dogs
Regularly visited by dogs
Infrequent contact with dogs
No experience with dogs
When meeting and interacting with dogs, your pet generally... (check all that apply)
Gets along with all
Is selective with new dogs
Prefers female dogs
Prefers male dogs
Prefers small dogs
Prefers large dogs
Loves to play
Remains calm
Avoids dogs
Ignores dogs
Appears fearful
Is possessive of toys, food or people
Is aggressive
Needs supervision
Would you recommend placing your pet in a home with dogs?
Yes, any
Yes, but with restrictions
No
Please describe your pet's experience with cats:
Has lived with cats
Regularly visited by cats
Infrequent contact with cats
No experience with cats
When meeting and interacting with cats, your pet generally... (check all that apply)
Gets along with all
Is selective with new cats
Prefers female cats
Prefers male cats
Loves to play
Remains calm
Avoids cats
Ignores cats
Appears fearful
Is possessive of toys, food or people
Is aggressive
Needs supervision
Would you recommend placing your pet in a home with cats?
Yes, any
Yes, but with restrictions
No
Has your pet lived with any other animals, other than cats and dogs?
Yes
No
If yes, please list the type of animal(s) and describe how well your pet did/did not get along with the other animal(s):
Please use this space for any additional information you would like us to know about your pet:
QUESTIONS FOR DOGS ONLY
What is your dog's exercise routine? (check all that apply)
Goes for walks
Goes for runs
Plays in the yard
Spends time in the yard only (no walks)
Does not exercise (lap dog)
Anything else regarding your pet's exercise or duration of exercise?
How many hours per day is your dog left alone?
Is your dog housetrained?
If your dog has accidents, please describe if the accidents are every now and then or more frequent. And under what circumstances may your dog have an accident in the house?
Has your dog been through any obedience training? (check all that apply)
No
Puppy Class
Beginner Obedience
Agility
Service Training
Guard Training
Home Training
What commands does your dog know? (check all that apply)
Sit
Stay
Down
Speak
Shake
Roll over
Heel
Crawl
Is your dog crate trained?
Has your dog ever escaped from you or your yard? (check all that apply)
No, never
Door dashed
Broke fence or gate
Chewed through or broke rope or chain
Jumped or climbed over a fence
QUESTIONS FOR CATS ONLY
Is your cat litter box trained? (check all that apply)
Uses a litter box
Has occasional accidents outside the litter box
Has frequent accidents outside the litter box
Goes outdoors
Sprays
What type of cat litter does your cat prefer?
Under what circumstances may your cat not use the litter box?
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