Pet adoption application

Name*

First NameLast Name

Email*

example@example.com

Birthdate

Date

Phone Number*

Please enter a valid phone number.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Animal(s) interested in adopting dog/cat and if you know name

If the above animal has already been adopted, would you be interested in another if we were to suggest a similar animal?

yesNo

Would this be your first pet?

YesNo

What type of dwelling do you live in?

ApartmentCondoHouseTrailer

Do you rent or own?

RentOwn

If you rent, please provide your landlord's name and phone number.

How long have you lived at current address? Number of people in house? Names and Ages of children?

Current employer and how long?

Please list any animals you've had in the past five years (include names, type of pet, breed, age, gender, spayed/neutered status, indoor or outdoor pets)

How many animals do you currently have?

Who is your current veterinarian? (If you do not have a vet, who do you intend to use as a vet for this pet? Name and Number.

Are your animals up to date on shots?

Are your animals spayed/neutered?

If your current animals are not up to date on their shots and/or are not spayed/neutered, please explain why. ( note we will confirm this with vet)

What are the names of your current pets?

Reference #1: Please provide the name and phone number of a personal reference (who does not live with you) that we can contact. *

Reference #2: Please provide the name and phone number of a personal reference (who does not live with you) that we can contact.

What is it about this particular animal that draws your interest?

What is your reason for wanting to adopt a cat/dog?

If your adopted animal has behavioral issues, how will you deal with those? (What if s/he claws your furniture? Gets on surfaces you do not wish them to jump on? Nips at your hands too hard? Chews on shoes, etc.?)

Will you crate your pet?

If you have to leave town, emergently or planned, where would your pet stay?

Have you ever been convicted of an animal related crime, such as cruelty to animals, animal theft, or animal abandonment?

YesNo

Are you aware that a new environment is stressful for your pet, and they may exhibit uncharacteristic behavior?

yesno

Do you understand that a dog can be an 18 year commitment, and can cost $300 - $500 per year to care for?

YesNo

Complete the statement " I want to adopt this dog...."

Please take time to think, be honest with yourself and us when answering this question. What are you absolutely NOT willing to deal with at the time of adoption or at any time during the life of the dog?

Do you have any additional comments, questions or concerns? Anything else you would like us to know to help match you up to a dog?

I understand that completing this application does not guarantee I will be allowed to adopt a dog, and that the application is a tool to help Healing and Hope Animal Foundation determine if this dog and my family are a good fit for each other. I acknowledge that all information provided on this form is true and correct. I understand that any misrepresentations may result in my not being approved and/or removal of the adopted dog from my possession. I also certify that I have never been convicted of animal cruelty or neglect.

I agree to allow a representative from Healing and Hope Animal Foundation to contact my vet for a reference and also agree to allowing a home visit prior to adopting this dog. If I am approved to adopt a dog, I agree to pay a non-refundable adoption fee and sign an adoption contract at the time of adoption.

I understand that all dogs adopted from Healing and Hope Animal Foundation will be spayed/neutered (age appropriate), heartworm tested (it is highly recommended to retest in 6mths as Heartworm can take 6mths to show on test from infection), fecal tested, and vaccinated(boosters may be needed) prior to adoption.

Signature

Date