Adoption Application Form

Homeward Bound Animal Haven

Adoption Application
Name of Animal:
Date:

MonthDayYear
Date
In order to be considered as an adopter you must:
- Be 18 years of age or older
Pet ownership is a serious responsibility. The policy of this adoption group is to ensure that each person who adopts a pet is aware of the responsibility, and is capable and willing to accept that responsibility morally, physically and financially.
Name:
Phone Number

Area CodePhone Number
Email:
example@example.com
What is the best way to contact you?
Address

Address

Street Address Line 2

CityState / Province

Zip
Occupation:
Driver’s License Number
Do you understand that adopting an animal could be a commitment for up to 18 years?
Please list the name, age and relationship to yourself of each person currently living in your house (ex Mary, spouse 35)
Does anyone living in your home have any known pet allergies?

Yes No
Your type of dwelling:

HouseCondoApartmentTownhouse
Your type of dwelling:

OwnRent
Length of time at current residence?
If you rent, are pets allowed?

YesNo
Why do you want to adopt at this time?

Companion for you / family / another petAdd a member to the familyGift (for whom)Other
Where will your new pet spend the majority of time?
When you are not at home, where will the new pet stay?
PAST/PRESENT PET HISTORY
Where do your pets stay if and when you travel?
Please list the name, type, age, gender, and if pet is spayed or neutered of ALL current animals. (example: Duke, Yellow lab, 1 year old, male, neutered)
What happened to your previous pets?
Are your animals current on all vaccinations?

NoYesOther
Date of last vaccinations:

MonthDayYear
Date
If adopting a CAT, do you plan to declaw?
Are you willing, able and committed to take responsibility for the medical care of this animal? (Shots up to date, annual vet exam, emergency or chronic veterinary care if needed?
Name of current or last veterinarian? Name/phone number?
May we contact this vet as a reference?

YesNoOther
What would you do with your pet if you could no longer care for your pet?
Have you ever surrendered a pet to a shelter/pound?

YesNo
If yes, why?
Would you allow an inspection of your home and/or yard?
How did you hear about Homeward Bound Animal Haven?
I Affirm that the information provided is true to the best of my knowledge.

Yes
THANK YOU FOR TAKING THE TIME TO COMPLETE THIS APPLICATION!
Should be Empty:

Homeward Bound Animal Haven

In order to be considered as an adopter you must:

PAST/PRESENT PET HISTORY

THANK YOU FOR TAKING THE TIME TO COMPLETE THIS APPLICATION!