ADOPTION QUESTIONNAIRE for Hayward Animal Services

ADOPTION QUESTIONNAIRE

HAYWARD ANIMAL SERVICES BUREAU
Welcome!

We are here to help match you with an animal companion who will be your lifelong friend. Please fill out the following application carefully and completely. This applciation has been designed to help us in making the best possible placement for you and an animal. This application does not guarantee an adoption from the Hayward Animal Shelter.

Please only submit one application.
IN ORDER TO BE CONSIDERED FOR AN ADOPTION, YOU MUST:
- Be at least 18 years of age, and have a permanent residence.
- Have a valid Military or CA identification showing age and present address.
- Be willing and able provide training, medical care, and loving attention for your new animal friend.
- Live in Alameda, Contra Costa, Marin, San Francisco, San Mateo, or Santa Clara counties, should the animal you are adopting be unable to immediately be spayed or neutered.
- Understand that the Hayward Animal Services Bureau reserves the right to deny any adoption application.
PLEASE COMPLETE THE FOLLOWING:
Name*
Today's Date*

MonthDayYear
Date
Street Address and City*

Address

Street Address Line 2

CityState / Province

City
Zip*
Home Phone #*

Area CodePhone Number
Cell Phone #*

Area CodePhone Number
Email Address*
example@example.com
CA Driver License*
Expiration Date*

MonthDayYear
Date
Employer’s Name*
I live in a...*

HouseCondoApartmentMobile HomeOther
Do you live with parents or relatives?*
Do you own or rent?*
Have landlord's permission to have a pet?*

YesNo
May we contact your landlord?*

YesNo
Landlord’s Name*
Landlord's Phone #

Area CodePhone Number
How long have you lived at your present address?*
moving in the next 6 months?*
moving within the next 2 years?*
If “Yes,” what will you do with your animal?*
Number of Adults in household?*
Number of Children in household?*
List children’s ages?*
Do all members of the household favor the type of animal you want to adopt?*

YesNo
Does anyone in household have allergies to animals?*

YesNo
Interested in a specific animal? Let us know
name or ID number
Which family member will primarily be responsible for training, feeding, and general care?*
How many hours will the animal be left alone?*
Where will the animal be left during the day?*
Where will the animal be left at night?*
Will you use a leash to walk/exercise your pet?*

YesNo
Do you have access to a yard? *
Is it enclosed?*
Fence type?*
Fence height?*
How long do you anticipate your pet to live?*
If you no longer can care for your pet, what will you do?*
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:*

	TYPE/BREED	SEX/ALTERED	KEPT IN/OUT	LENGTH OWNED	CURRENT STATUS

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?*
If your new animal gets lost, please explain what you would do.*
What do you anticipate will be the average monthly cost of owning (feeding, caring, vaccinations, and providing medical care) for you pet? $ per month*
How often should your pet visit a veterinarian?*
What do you anticipate average cost of a veterinarian visit to be?*
Do you plan to spay or neuter your pet?*

YesNo
Why or why not?*
Will the pet you adopt be gift? If yes, for who?*
Do they reside with you?*
If you are interested in a puppy or a kitten, what type of behavior do you expect from it?*
If you are interested in an adult pet, what type of behavior do you expect from it?*
Will your pet wear identification or license?*

YesNo
If yes, what kind?*
How will you transport your pet in a vehicle?*
How much time would you allow for your new pet to adjust to its new home and/or other pet?*
What will you do to help your pet to adjust?*
What type of accessories do you anticipate needing for your pet?*
Do you plan to crop ears or tail, or de-claw your pet?*
If Yes, Why?*
Optional: Upload proof of address and proof of valid photo ID ( Ex. a photo of valid driver's license and a piece of mail such as a utility bill). Please note, if you would prefer, you may do this in person at the time of you appointment. Providing this information ahead of time just speeds up the process a little.

Browse Files
Upload proof of photo ID and Proof of Address Cancelof
I understand that in the event the original owner of a stray animal is found within thirty days of the adoption, I will return and surrender the adopted animal to Hayward Animal Shelter upon request.

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.
ALL ADOPTED ANIMALS ARE TO BE STERILIZED
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

ADOPTION QUESTIONNAIRE

IN ORDER TO BE CONSIDERED FOR AN ADOPTION, YOU MUST:

PLEASE COMPLETE THE FOLLOWING:

ALL ADOPTED ANIMALS ARE TO BE STERILIZED