HAINES ANIMAL RESCUE KENNEL ADOPTION APPLICATION

Pet Information

Name of Animal Requested

Date

Species

Breed(s)

Gender

Tell Us More About You

Name

Mailing address

Physical address

City

State

Zip

Phone (H)

Phone (C)

Email

example@example.com

Employment Information

Employer

How long there?

Job Title

Housing Information

Type/size of housing

How long there?

Any children in home?

If so, how many?

Children(s) age

Are you renting (if no, skip to "Current Pet History")?

If renting, does your landlord know you plan to add a pet you family?

Can you provide proof of "pets allowed" rental agreement?

Landlord's name/phone

Current Pet History

Do you currently own any pets (if no, skip to "Previous Pet History")?

Tell us about your pets (species, age, sex, altered)

What vaccines do your pets have?

Are your pets licensed?

Have your pets been around the kind of pet you plan to adopt?

Past Pet History

Have you owned animals in the past (if no, skip to "Questionnaire")?

Tell us about the pets you have owned (species, age, sex, altered)

Questionnaire

How will your daily life include this animal?

What do you feel are the most important things that this new pet will need?

Who will be the primary care giver of this animal?

Where will your pet stay when you are gone?

Have you ever been responsible for a special needs animal?

If this pet develops a special need, is your family ready to commit to the energy and resources to care for this animal? (Examples: physical therapy, medications, special dietary foods etc

References

Name

Phone

Address

Relationship

Second Reference

Name

Phone

Address

Relationship

Any additional comments?

I certify that the above information is true and accurate to the best of my knowledge and that falsification of information can be cause for denial of my application. I acknowledge that the history of this animal may be unknown and that HARK makes no warranty regarding health of temperament of this animal.

Print Name

Signature of Applicant

Date