Adoption Application

Main Applicant*

First NameLast NameAge

Co-Applicant (If main applicant is under 18 or older than 65)

First NameLast NameAge

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Main Contact Number*

Secondary Contact Number

E-mail*

example@example.com

Employer*

Occupation*

What type of pet are you interested in?

Male or Female*

Type*

Personality Type*

Name of Pet you are interested in

Why do you want to adopt a pet?*

How many adults reside in your home?*

How many children reside in your home?*

Ages?

For whom are you adopting the cat?*

Does any member of your family have an allergy to animals?*

Please explain allergies

Who will be responsible for the pet's care?*

Where will the pet be kept?*

If/When outdoors the pet will be

AttendedUnattendedCollar and Tags

If applying for a cat, are you planning on declawing?*

YesNoNot Sure

What best describes your housing?*

OwnerLive with ownerRelative of ownerRental

If no one is home, where will the pet be kept?*

If you rent/do not own, please provide the property owner's name and contact number or attach a letter from you landlord or copy of your lease stating that you are allowed to have pets.

Property Owner

Phone Number

Please enter a valid phone number.

If you move, what will you do with the pet?*

Have you ever adopted an animal from a rescue/animal control agency before?*

YesNo

Have you applied to other shelters for adoption recently? If so, please list:*

Have you ever surrendered an animal to a rescue or had an animal euthanized?*

YesNo

If yes, please explain briefly:

Describe any pets you have had in the last 5 years, including small animals, reptiles, birds, etc:

Name Name
Type Animal Type
Age Age
Years in your Care Years in Care
Spayed/Neutered? Spay or Neuter
Is pet current? If not, please list the reason pet is no longer with you. Reason

Current or most recent veterinarian:*

NameVet Phone

Please call your veterinarian in advance and gran them permission to speak with a Hearts4Paws representative about your pet's history.

Please provide 2 personal references (not family members).

NamePhone

What precautions will you take to properly introduce your new pet into your home, if you have other animals?*

If a behavioral problem arises, what steps will you take to work on it?*

Are you willing to sign legal pet adoption papers?*

YesNo

Are you financially willing and able to provide annual checkups, vaccinations, and any and all medical care necessary for this pet?*

YesNo

Do you agree to permit a visit to your home by appointment?*

YesNo

By signing this form, I/we acknowledge that all information on this form is true and correct. I/we understand that any misrepresentation of fact may result in Hearts4 Paws,Inc. refusing adoption privileges to me/us. If my/our request for adoption is approved and later Hearts4Paws,Inc. discovers the above information is not true or correct, Hearts4Paws,Inc. reserves the right to remove the adopted cat from my home/farm.

Main applicant signature:*

Date Signed*

Date