Adoption Application

Main Applicant

First NameLast NameAge

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

First NameLast NameAge

Main Contact Number

Format: (000) 000-0000.

Secondary Contact Number

Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState

Zip Code

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

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

What best describes your housing?

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.Format: (000) 000-0000.

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

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

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?

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?

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

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

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