Adoption Application

Full Name*

First NameLast Name
Spouse/Significant Other

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*
Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
EmailTextCallOther
Occupation*
Employer's Name*
Please list all members of your household, including ages*
Do you own or rent your home?*
If renting, are pets allowed by your landlord?
Do you have a secure outdoor area/fenced yard?*
Are you planning on moving within the next 6 months? If yes, what are your plans for your pets if you move?*
Is anyone in your household allergic to pets?*
Is everyone in your household in agreement with the decision to adopt a dog?*

Who will have primary responsibility for this dog's daily care?*
Who will have financial responsibility for this dog?*
Number of dogs in your household?*
Breed, gender, and ages of these dogs?*
Number of cats in your household?*
Are they spayed/neutered? If not, why?*
Are all current pets on vaccinations? If not, why?*
Do you own any other animals? If so, please list them.*
Have you ever surrendered a pet? If so, why?*
Name of current or previous veterinarian. If this is your first pet, please include the veterinarian you intend to use.*
Veterinarians address?*
Veterinarians phone number?*
Please enter a valid phone number.Format: (000) 000-0000.

All medical treatment for this dog since their arrival at the shelter has been received at the Holdenville Veterinary Clinic, 601 Kingsberry Rd, Holdenville, OK, from Dr. Rebekah Hartfield or a member of her medical team. A detailed record of this treatment may be obtained through them. The Holdenville Animal Lovers Organization (HALO) has paid for all food, spay/neuter, vaccinations, flea/tick/heartworm treatment, and any additional medical needs to ensure this dog's health.
Please read the following statements and mark the checkboxes as agreement.*
I acknowledge that I have read and fully understand the terms and conditions of the foregoing adoption contract and that I will comply with the same.
Adopter's Signature:*

Clear
Thank you for adopting a dog from our shelter!
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