Hayward Animal Services BureauAdoption Questionnaire
Thank you for choosing adoption!
This application does not guarantee an adoption from the Hayward Animal Shelter.
In order to be considered for an adoption, you must:
Be at least 18 years of age.
Have a valid military, passport, or a valid ID from the DMV
Understand the hayward Animal Services Bureau reserves the right to deny any adoption application.
PLEASE COMPLETE THE FOLLOWING:
Name
*
First Name
Last Name
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Main Phone
*
Format: (000) 000-0000.
Alternate
Format: (000) 000-0000.
Email Address
*
example@example.com
Do you live in a:
House
Condo
Apartment
Mobile Home
Other
Do you own or rent?
*
Have landlord's permission to have pets?
*
Yes
No
Landlord's Name
First Name
Last Name
Phone #
Format: (000) 000-0000.
How long have you lived at current address
*
Number of Adults in household?
*
Number of Children in household?
*
List children's ages?
*
Do all family members favor this type of animal?
Yes
No
Does anyone in the household have allergies to animals?
Yes
No
Are you currently employed?
Do you have access to a yard?
Is it enclosed?
Fence type
Height?
If you no longer can care for your pet, what will you do?
Back
Next
Have you ever brought an animal to the shelter? If so why?
Pet History: List animals currently and previously owned in the past 5 years:
Rows
TYPE/BREED
SEX/ALTERED
KEPT IN/OUT
LENGTH OWNED
CURRENT STATUS
1
2
3
4
If you no longer own the above animal(s), please explain what happened
If you currently own a pet, what veterinarian does your pet visit?
I certify that the above information is true and correct to the best of my knowledge. I understand that City of Hayward Animal Services Bureau reserves the right to deny the adoption of any animal. I further understand that failure to comply with the Adoption Contract regulations such as spaying/neutering, licensing, and general medical care could result in forfeiture of deposit, possible legal citation, and my inability to adopt any future animals from the Hayward Animal Services Bureau.
Signature
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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