HGAS - ADOPTION APPLICATION

HIGHER GROUND ANIMAL SANCTUARY - ADOPTION APPLICATION
Mission Statement: To find caring, loving, permanent homes for surrendered, abandoned or neglected animals. Higher Ground Animal Sanctuary hopes to ease the problem of the population overflow occurring in many of our shelters today. We educate the individual on the importance of commitment to an animal for their life, spay and neutering ALL pets, and providing superior care and compassion. Higher Ground Animal Sanctuary is funded solely on donations and composed of a network of All- Volunteer foster families and we are always in need of finding more foster care providers with the time and commitment to provide care for these animals in transition. We also are in need of people to provide transportation for these animals. If you would like to donate, transport or become a foster please let US know!
Date Submitted*

MonthDayYear
Date
Are you interested in a particular animal?*
Who?*
Why?*

APPLICANT INFORMATION

All applicants must be over the age of 18. If married or jointly adopting an animal all individuals must be listed and complete the application.
Name*
Physical Address*

Mailing Address

Street Address Line 2

CityState

Zip
Physical and mailing address the same?*

YesNo
Mailing Address

Physical Address

Street Address Line 2

CityState

Zip
Home Phone
Cell Phone*
Work Phone
Email*
example@example.com
Joint Applicant?*

YesNo

SPOUSE/JOINT APPLICANT
Name
Physical Address

Physical Address

Street Address Line 2

CityState

Zip
Physical and mailing address the same?

YesNo
Mailing Address

Street Address

CityState / Province

Postal / Zip Code
Home Phone
Cell Phone
Work Phone
Email
example@example.com

EMPLOYMENT INFORMATION
Employer
Occupation
Address

Address

Street Address Line 2

CityState

Zip
Phone Number
How long at present job

SPOUSE OR JOINT APPLICANT EMPLOYMENT INFORMATION
Employer
Occupation
Address

Address

Street Address Line 2

CityState

Zip
Phone Number
How long at present job

REFFERENCES
Name*
Relationship*
Years Known
Address

Address

Street Address Line 2

CityState

Zip
Home Phone*
Best time to call

HOME ENVIRONMENT INFORMATION
Do you live in a:*
Do you own or rent your residence*
*If renting, please confirm you have your landlords' permission to keep a dog, and are there any weight restrictions?
Landlords contact information:
Name
Phone Number
*Please prepare a copy of your lease If you live in a condominium/co-op or your house is part of a homeowners association, please provide a copy of the bylaws, rules and regulations of such organization stating that there are no restrictions regarding owning a dog. If there is a limit on the number of pets you are allowed, please note the limit on the copy of the bylaws.
How long have you lived at this address*
What size of yard is totally fenced for dog*
Do you have a fenced yard?*
Fence Type Height*
Does fencing completely enclose a yard for a dog*
If no fence how will you handle the dogs exercise and potty needs etc*
How many adults in the household?*
How many children in the household?
Age of children
Do you or does anyone in your family have allergies
Are all family members in agreement about adopting a this animal?
Do you own cats
How many cats
Are they indoor or outdoor
Are they spayed or neutered
Do you have other animals
Do you have a regular veterinarian?*
Veterinary clinic name*
Address

Address

Street Address Line 2

CityState

Zip
Phone Number
Fax Number
Name of Veterinarian for current and/or previously owned animals
Do you authorize Higher Ground Animals Sanctuary to contact your veterinarian for your vet history
Have you ever re-homed a dog? If so when and why?

CURRENT ANIMALS
How many dogs & cats have you owned in the last 15 years?*
List all animals you presently own:
Animal 1
Name
Type
Age
Sex
Spayed/Neutered?
Animal 2
Name
Type
Age
Sex
Spayed/Neutered?
Animal 3
Name
Type
Age
Sex
Spayed/Neutered?
Animal 4
Name
Type
Age
Sex
Spayed/Neutered?
Animal 5
Name
Type
Age
Sex
Spayed/Neutered?
Would you describe your current dog as alpha or submissive to to other dogs? Answer explain:
Have you owned a dog before*
Describe your ideal dog*
Regarding the animal you are looking to adopt;
Why did you choose this animal?*
In your research of this breed is there anything that might be an issue for you*
List all the plans for this pet*
Do you want to adopt a male or female*
Where will the dog spend the day*
Where will the dog spend the night*
On average how many hours will the dog spend without human company each day*
Do you agree to license this dog and provide him/her with regular healthcare?*
Do you agree to a home visit by a HGAS representative by appointment?*
Do you agree to contact HGAS in the event you can no longer keep this dog?*
In the event we do not have a dog that fits your needs do you give HGAS permission to share your application with other rescue organizations?*

Agreement

All of the above information I have given is true and complete. If I adopt a dog from the Higher Ground Animals Sanctuary, the dog will reside in my home as a pet. I will provide him/her with adequate water, a high quality dog food, shelter, training, affection and medical care. I understand that the Higher Ground Animals Sanctuary is a referral service and is not responsible for the accuracy of information received about the habits, temperament, or physical condition of the dogs available for adoption. I understand it is my responsibility to evaluate a dog for myself before agreeing to adopt him/her. I am in full agreement of the terms of the adoption. The Higher Ground Animals Sanctuary shall not be liable for, and is hereby relieved from, all liability for any damage, expenses, causes of action, fines, suits, demands, judgments, or claims of any nature whatsoever arising from or by any reason of any damage to property or injury to any persons caused in whole or in part during the visitation of the dog up for adoption and a dog placed in your home. I hereby accept and assume such liability and agree to protect, indemnify and hold the Higher Ground Animals Sanctuary harmless from and against all of the aforesaid. Completing, signing and returning this document constitutes your permission for US to check
WE RESERVE THE RIGHT, IN OUR SOLE DISCRETION, TO REFUSE ANY APPLICATION FOR ANY REASON WHATSOEVER.
I ACKNOWLEDGE THIS DISCLAIMER*

I UNDERSTAND
Applicant #1 Signature*

Clear
Date

MonthDayYear
Date
Applicant #2 Signature

Clear
Date

MonthDayYear
Date
Both parties agree that this application can be executed by the applicant and sent to Higher Ground Animal Sanctuary via hand delivery, US Mail, Federal Express or any other recognized overnight delivery service or by email. If the applicant would like to send the document via email, applicant and the Higher Ground Animals Sanctuary both agree that the applicants digital signature is valid and binding upon the parties.
Should be Empty:

HIGHER GROUND ANIMAL SANCTUARY - ADOPTION APPLICATION

APPLICANT INFORMATION

SPOUSE/JOINT APPLICANT

EMPLOYMENT INFORMATION

SPOUSE OR JOINT APPLICANT EMPLOYMENT INFORMATION

REFFERENCES

HOME ENVIRONMENT INFORMATION

CURRENT ANIMALS

List all animals you presently own:

Animal 1

Animal 2

Animal 3

Animal 4

Animal 5

Regarding the animal you are looking to adopt;

Agreement

WE RESERVE THE RIGHT, IN OUR SOLE DISCRETION, TO REFUSE ANY APPLICATION FOR ANY REASON WHATSOEVER.