Houlagans' Rest Adoption Application

Houlagans' Rest Adoption/Foster Application
Houlagans' Rest is committed to finding permanent, responsible, loving homes for all our animals. Please fill out the application in detail. Once completed, one of us will discuss it with you. The process of adoption includes the application, the interview, and the approval. Please be aware that the interview process will not be done today. Depending on time, call back should be made by mid-week for completed adoptions. Thank you for your time and cooperation.
Applicant's Name*

First NameLast Name
SS# Last 4 digits*
Cell phone
Either a cell or home number is requiredFormat: (000) 000-0000.
Home phone
Format: (000) 000-0000.
Email*
Are you over 21?*

YesNo
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long at this address?*
Do you agree to a home visit?*

YesNo
Are you a student?*

YesNo
School Hours
Occupation(s)/Location/Hours*
Are you:*

SingleMarriedIn committed relationshipEngaged
Do you live*

AloneWith roommatesWith family
- Spouse/Partner Occupation(s)/Location/Hours
- Who will be responsible for the pet?
- How many adults (21 & older), including yourself, are in the household?
- List all the adults in the household:
- How many residents are under 21
- List their ages
- Do all of the adults in your household know that you are planning to adopt a dog?
  
  YesNo
- Does anyone in the household have allergies?*
  
  YesNo
- Explain
- If you have no children at the present time, will the arrival of children as members of your household affect your commitment to love and care for your pet?*
  
  YesNoDon't know
- Do you anticipate any major lifestyle changes in the next two years? (moving, marriage, school, new baby)*
  
  YesNo
- Explain
- Residence Information
- Do you:*
  
  OwnRent
- Type of Residence*
  
  HouseCondoTownhouseApartmentMobile home
- What style is your residence (ranch, split level, etc.)?*
- How many floors are in your residence?*
- What floor do you live on*
- Landlord's name and phone
- List any restrictions on pets where you live (type, breed, number, size)
- Do you have a fenced yard:*
  
  YesNo
- Are you considering getting one?
  
  YesNo
- What type of fence:
- Type of fence:
- Height
- Area (Sq Ft)
- Do you have a dog pen:*
  
  YesNo
- Do you have a dog house:*
  
  YesNo
- How will the dog get exercise?*
- Do you want to:
  
  FosterAdopt
- Name of dog(s) you are interested in:*
- What attracted you to these dog(s):*
- Why is this a good time for you to adopt a pet:*
- Who is the pet for:*
  
  SelfChildrenOther
- Age interested in:*
  
  PuppyYoung dogAdult dog
- What size adult dog are you looking for (lbs)?*
- What characteristics are you looking for in a pet:
  
  housebrokenlaid-backobedience trainedenergeticnon-chewerplayfulgood guard doglikes to runindoor dogoutdoor doggood with other dogsgood with catsgood with childrengood with adultsOther
- What role will your dog fill in your household? *
  
  family petfor childrenhunting dogcompanion for other petguard dog for businessprotectionOther
- Current Pets
  
  None
- Current Pets List*
- Are current pets housed inside or outside:
- How might your current pets react to the new dog:
- Other pets owned in the past five years:
  
  None
- Other pets (excluding current)*
- Have all of your pets, past and present, been spayed or neutered:
  
  YesNo
- Why were they not spayed or neutered?
- We require a vet reference. If you do not have one, we will accept a close family member's (does not need to be local). Please contact your family member and have them give the vet permission to speak to Houlagans:
- Client Name
  Person providing the vet reference
- Relationship to applicant
  Close family member requested
- Pet Name(s)
- Vet Office/Phone Number
- Please contact your vet reference and give them permission to speak to Houlagans' Rest.
- Vet you plan to use*
- Have you adopted from us in the past:*
  
  YesNo
- Have you adopted from another rescue group or shelter in the past*
  
  YesNo
- Name of group or shelter/Adoption Date/Where is pet now
- Have you ever surrendered or planning to surrender a pet to any shelter/organization?*
  
  YesNo
- Explain:
- Have you ever had a pet die of a contagious disease or unknown cause:*
  
  YesNo
- Explain:
- Home Care & Training
- Dog's location during the day:*
  
  InsideOutside
- Where
- Dog's location at night:*
  
  InsideOutside
- Where
- Where specifically will the dog sleep:*
- Where will your pet stay when you go on vacation:*
- Typical number of hours the dog will be home alone:*
- Daily time commitment to dog (hours)*
- If your new dog is not housebroken, what is your plan for housebreaking:*
  
  CratingPaper trainingOther
- How would you handle any problems with the new dog*
- Are you considering professional training?*
  
  YesNo
- With whom:
- What kinds of behavior do you find unacceptable? How would you handle them?*
- Would you seek professional assistance to solve these problems:
  
  YesNoMaybe
- References (Please provide 2)*
- By signing below. I certify that all information in this three-page application is true, and I recognize that any misrepresentation of facts may result in loss of adoption privileges. I authorize investigation of all statements in this application and understand that veterinarians, humane societies, landlord, and references may be contacted. I further understand that the adoption of an animal may be delayed to enable us to process this application and allow time for me to consider my lifetime commitment to the animal I have applied to adopt.
  
  WE reserve the right to deny an adoption to anyone who, in its opinion, will not provide a suitable home for the pet based upon this application and investigation of the information authorized
- Signature*
- Date*
  
  MonthDayYear
  Date
- Animal Cruelty Statement
  
  I, {applicantsName}, do hereby solemnly swear and affirm as follows:
  
  1.I have never been convicted of animal cruelty, neglect, or abandonment, pursuant to VA Code & 3.2-6548 (B) and (F); 2. I will provide YOU with any and all updates to the Animal Cruelty Statement as changes occur. Signature of all adult members of household:
- Signature*
- Date*
  
  MonthDayYear
  Date
- Signature
- Date
  
  MonthDayYear
  Date
- Signature
- Date
  
  MonthDayYear
  Date
- Signature
- Date
  
  MonthDayYear
  Date
- Should be Empty:

Houlagans' Rest Adoption/Foster Application

Residence Information