ADOPTION APPLICATION

Name of Pet You’re Interested In*

In the event this rescue animal is no longer available, is there another pet you’d be interested in? If yes, which pet?

How did you hear about us?*

Have you adopted from us before?*

Name of applicant*

First NameLast Name

Date of Birth*

Date

Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone Number

Area CodePhone Number

Cell Phone Number*

Area CodePhone Number

Email Address*

example@example.com

Spouse’s Name and DOB

Are you currently (check all that apply):*

Employed Full TimeEmployed Part TimeStudentRetired

If employed, name of Employer and Job Title:*

Length of time with present employer:*

If student, where?*

Spouse’s Occupation*

Spouse’s length of time at present employer:*

How many adults (18+) live in the household? Please list name, relationship, age and gender*

How many children live in the household? Please list name, relationship, age and gender*

Are ALL members of your household aware of and in agreement with this adoption? If no, please explain. *

Who will be the main caretaker of the pet?*

Do any members of your household have any known allergies to pets? If yes, please explain.*

Are all current pets spayed/neutered and up to date on vaccines?*

YesNo (please explain under “other”N/A- I do not currently have any other pets in my homeOther

Please list and describe all CURRENT PETS that reside in your home. Include name, sex, species/breed, approximate weight/size, personality, and any medical or behavioral conditions*

Have any of the above pets been cosmetically altered (debarked, declawed, docked tail, cropped ears, etc)? If yes, please explain*

Do your current pets where identification tags?*

Are your current pets licensed with your town/city?*

Are your pets on heartworm/flea and tick preventative?*

Who is your current veterinarian?*

Please list practice name, doctor, and phone #

Do we have permission to speak to your current veterinarian?*

If yes, please initial above

Do you own or rent your current home?*

Housing Type:*

If you rent, does your lease allow pets?*

How many pets does your lease allow?*

If renting, please provide the name and contact information for your landlord. Submitting a copy of your lease agreement/pet addendum with this application will help to expedite processing*

Do you have a backyard?*

Is your yard securely fenced?*

If yes, type of fence and it’s height:*

Do you plan on moving in the foreseeable future? If so, where will you move and why?*

What level of experience do you have with dogs? Check all that apply*

Please list all PREVIOUS PETS. Please include name, species/breed, age, and why they are no longer with you*

Have you ever surrendered an animal to a shelter/rescue? If yes, please explain the circumstances*

Why do you want to adopt this pet? Check all that apply*

If this pet is a gift/surprise, please explain*

Sex*

FemaleMaleNo preference

Activity Level*

High (daily running, hiking, etc)Medium (likes to play in the yard and go for daily walks)Low (couch potato, likes to go for casual walks)No preference

Size*

Small (0-25lbs)Medium (25-60lbs)Large (60-100lbs)Extra Large (100lbs+)

Age*

Baby (8 weeks - 5 months)Young (6 months - 1 year)Adult (1 year - 7 years)Senior (8 years+)

Training*

Coat*

Low-shed or hypoallergenic (ex: poodle, westie)Short coat (ex: chihuahua, pit bull)Medium coat (ex: German Shepherd, Husky)Long coat (ex: Pomeranian, shih tzu)No preference

For some dogs, regular grooming is a necessity to ensure health and comfort. Are you willing to provide your pet with regular, professional grooming if/when necessary?*

Are you willing to provide your pet with basic training, even if means consulting a professional?*

YesNoMaybe (please explain in “other”)Other

Are you willing to provide your pet with behavioral modification should the need arise?*

YesNoMaybe (please explain in “other”)Other

What behavioral issues would you deem cause for returning/surrendering the rescue pet?*

What activities will your pet take part in/where will they go on a regular basis?*

Are there any breeds you wish to stay away from?*

Are there any other qualities, not mentioned above, that you would like your new pet to have?*

Elderly*

SometimesAlwaysNever

Young Children (under 10)*

SometimesAlwaysNever

Children (over 10)*

SometimesAlwaysNever

Dogs*

SometimesAlwaysNever

Cats*

SometimesAlwaysNever

How long will your pet be alone each day?*

Is this time consecutive?*

Where will your pet live?*

Indoors with me and my familyOutdoorsGarage/basement

When your pet is alone inside, where do you plan to keep them? Check all that apply*

Free reign in homeCrateGated/closed roomBasement/garage

Will your pet be allowed on the furniture?*

YesNoSome

Where will your pet sleep at night?*

With meCrateKitchen/living roomBasement/garage

Will your pet be allowed to spend time outside unsupervised?*

No, my pet will always be leashed or supervisedYes, please explain in “other”Other

If/when you go on vacation or are temporarily unable to care for your pet, where will they stay?*

My pet will come with meMy pet will stay with a friend or relativeMy pet will be boarded/kenneledOther

Please provide two personal references. Include name, relationship, and contact number.*

Please virtually sign after reading and agreeing to the following terms:

I. I release and hold harmless Homeward Bound Animal Rescue and it’s board members, agents, volunteers, fosters, representatives and any other associated individuals from any and all claims and actions whether it is property damage caused by the foster/adoptive animal(s), personal injury to myself, my family, other people, or other animals including biting, scratching, transmittal of disease, and/or any other matter attributable to said animal(s).

II. Homeward Bound Animal Rescue will not be held responsible for any medical bills incurred after adoption unless otherwise arranged for at time of adoption.

III. Homeward Bound Animal Rescue and the individuals associated with it’s mission are not responsible for any errors in the information provided about this rescue pet. This includes, but is not limited to, breed description, health, and behavior.

IV. Homeward Bound Animal Rescue reserves the right and maintains sole discrestion to reclaim any animal that is found to be chained, neglected, abused, or improperly cared for in any capacity.

V. Furthermore, if I am unable or unwilling to keep possession of the animal, I am required to contact Homeward Bound Animal Rescue immeadiately. The animal must be returned only to Homeward Bound Animal Rescue in the event the adopter is no longer able to care for said animal. If the animal is surrendered back to Homeward Bound Animal Rescue, I hereby agree to pay a surrender fee in the amount of one hundred and fifty dollars ($150). The surrender fee may be waived at the sole discretion of Homeward Bound Animal Rescue.

By virtually signing below, I certify that all provided information is true and I understand that any misrepresentation of facts will result in me losing the privilige to adopt from Homeward Bound Animal Rescue and/or the forfeiture of this animal. I acknowledge on behalf of myself and my family that I understand and agree to the above terms and conditions.

Signature*

Date*

Date

ADOPTION APPLICATION

Household Information

Housing Information

Prior Pet Experience

What are you looking for in your new pet?

How often will your pet interact with the following?

Pet’s Schedule

Personal References