Helping Paws - Adoption/Foster Application

Helping Paws - Adoption/Foster Application
Your Name*

First NameLast Name
Applying for:*
Name of Helping Paws Pet
How did you hear about us/pet you are applying for?*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Alternative Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
How long have you lived in your current address?*
Do you rent or own?*
If you rent, please list your landlord's name and phone number:
You must have a valid driver's license or other government-issued photo ID to adopt a pet. *
ID Type
ID Number
How many other adults (18+) live in your home?*
Please list all adults' full names:
If children in the home please list kids' ages:
Check all that apply:*

I have owned a pet before.I currently have a pet.I have had a pet within the last 5 years.I had a pet more then 5 years ago.I had a pet as a child growing up.I've never had a pet and this would be my first.There are currently pets in my home but they aren't mine.
Please list all current and former pets (Name, Species, Breed, Spayed or Neutered?, Age/Years Owned, Currently in Home?, Veterinary Practice Used)
Check all that apply:*

Given/sold a per to another personGiven a pet to a shelterHad a pet run awayHad a pet die in your careHad to euthanize a petNot applicable
Is anyone in the house allergic to animals?*

Very allergicMildlyNo AllergiesUnsure
Do all the members of your household agree on adopting?*

YesNot sureIt's a surprise
Where will the pet be allowed in your home (check all that apply)?*

Inside onlyInside with free access to outsideInside with supervised time outsideOutside onlyCrateBasementGarageOther
Do you have a fenced in yard?*

YesNo
Why are you interested in adopting or fostering? *
How long during the day will the pet be left alone?*
Will the pet be crated or confined when no one is home? If no, where will the pet be kept?*
How much can you budget monthly for supplies and medical expenses?*
Do you agree to provide regular healthcare by a licensed veterinarian?*

YesNo
Please list any and all veterinary practices you have used:*
Anything else we should know?
Please list two references: *

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Please read and check off to acknowledge each of the following items:*

I certify that I am adopting this pet for myself, and that I am permitted to have this pet in my home.The information I have provided on this application is true to the best of my knowledge. I understand that if I willfully provide false information, my application may be denied.In the event I can no longer keep the animal I adopt, I will contact Pennsauken Animal Hospital.
Signature*
Date*

MonthDayYear
Date
Should be Empty: