Adoption Application

Full Name*

First NameLast Name
Spouse/Significant Other

First NameLast Name
Date of Birth*

MonthDayYear
Date
Phone Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
How would you like us to contact you to inform you that your application has been accepted? If we don't receive a response back in 24 hours then we will assume you are no longer interested.*

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.

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:*

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Thank you for adopting a dog from our shelter!
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