Adoption Application

(765) 962-6811 2101 West Main Street Richmond, IN 47374 www.helptheanimalsinc.com

I'm interested in adopting:

DogCat

Animal Name (if known)

TO BE COMPLETED BY PERSONS 18 YEARS OF AGE OR OLDER:

Name

First NameLast Name

Middle Initial

Birthday

Date

Phone

Co adopter Name

Middle Initial

Birthday

Date

Phone

Address

Street Address Line 2

CityState

Zip

Email

example@example.com

May we share your contact information with Hills Pet Food Products?

YesNo

Do you:

Own your property (your name is on the Deed)Rent your property

If your name is not on the property deed, please provide name and phone number for landlord/owner:

Is your yard fenced?

YesNo

If yes, what is the height?

Veterinarian name

Veterinarian phone

In whose name are the vet records listed under?

May we contact your veterinarian?

YesNo

Please list the full names and ages of everyone who lives in the home:

Where will the animal be kept?

In the houseOutsideIn a barn

Please explain

Do you plan on any physical alterations such as ear cropping, declawing, etc.?

YesNo

If yes, please explain

Please list the pets CURRENTLY living in your home:

Name: Breed: Age: Spayed/neutered? Yes No

Please list the pets you have had in the past:

Name: blanks Why is this pet no longer with you? blank

By signing below, I certify that all the information contained herein is true and complete. I agree to provide identification at the request of HELP the Animals, Inc. in the form of a valid Driver's License or State-issued identification. I further understand that any false information, omissions, or misrepresentations can render this adoption application void and can be rejected and/or terminated at any time.

HELP the Animals, Inc. has the right to refuse any adoption for any reason. I understand and agree that this animal is adopted 'as is' in regard to any known and/or unknown health and behavior issues now or in the future.

Adopter Signature