Healing Angels Animal Rescue Adoption Application Form

Healing Angels Animal Rescue

Adoption Application
Application Lodgement Date:*

MonthDayYear
Name of Animal:*
Is this Animal a Dog or Cat?*
In order to be considered as an adopter you must:
- Be 18 years of age or older
- Have identification showing your home address
- Have the knowledge and consent of your landlord (if applicable)
- Be willing and able to provide a loving, safe and nurturing environment for this animal
- Be willing and able to provide any necessary medical care for this animal
Pet ownership is a serious responsibility. The policy of our rescue is to ensure that each person who adopts an animal is aware of the responsibility, and is capable and willing to accept that responsibility morally, physically and financially.

Please be sure to ANSWER ALL QUESTIONS and feel free to add your own comments.
If a question does not apply please state N/A.
Applicant/s Name/s:*
Are you 18 years of age or older?*

YesNo
Contact Number:*

Area CodeHome or Mobile Number
Email:*
example@example.com
What is the best way to contact you?*

PhoneEmail
Home Address:*

Street Address

Street Address Line 2

CityState

Post Code
Please list the name, age and relationship to yourself of each person living in your home (e.g. Jane Wife 35)*
Does anyone living in your home have pet allergies?*

YesNoUnknown (never owned a pet)
Your type of residence:*

HouseApartmentTownhouseOther
Do you:*

OwnRent
If you rent, are pets permitted by the Landlord/Real Estate?

YesNo
If you rent, please provide your Owner/Agent Contact name, phone number and email:
Length of time you have been living at the residence:*
Do you plan to move within the next 6‐12 months?*

YesNo
Do all adults in your household know of and agree to an adoption of a new animal?*

YesNoNot Applicable
How do you intend to keep your new pet housed:*

Inside OnlyOutside OnlyCombination of Inside/Outside
If housed a combination of inside/outside please specify details (i.e. cat/dog door, enclosure/run):
How many hours per day on average will your pet be left alone?*

01-23-56-1011-1213 +
Do you have a secure fenced yard?

Yes - WoodYes - ColorbondYes - WireNoOther Type of FenceNot Applicable
If Yes, please specify the height of the fence:
Does your home contain:*

BalconyPoolCat/Dog Door/sUnscreened Doors/WindowsMesh Flyscreen Doors/WindowsMetal Security Screen Doors/WindowsCombination of Screen Door/Window Types
Do you travel?*

YesNo
If Yes, where would your pet/s stay when you travel?
Do you currently own an existing pet/s?*

YesNo
Do your current pet/s get along with other animals (friendly/social etc.)?*

YesNoUnknownNot Applicable (I do not own any other animal)
If Yes, please specify pet name, breed/s, age, gender, vet status. (E.g. Duke, Black Labrador, 1 Years Old, Male, Neutered/Vaccinated/Microchipped)
Is your pet/s up to date on all vaccinations?*

YesNo
If Yes, date of last vaccination given:

MonthDayYear
Your current or previous Vet Clinic/Name/Number:
May we contact this Vet as a reference?

YesNoNot ApplicableOther
Which of the following (if any) situations may cause you to give away your pet?*

Moving interstateMoving to a new rental 'no pets allowed'Pet has a medical conditionOwner has a medical conditionPet AllergiesToo expensiveRuins the furniture - digging - chewing etc.Getting a divorceHaving a new babyWould not give up for any reasonsOther
What would you do with your pet if you could not keep it for any of the reasons stated above?
Have you ever surrendered/rehomed a pet?*

YesNo
If yes, why?
Would you allow us an inspection of your home and/or yard if deemed required by us?*
How did you hear about Healing Angels Animal Rescue (HAAR)?*
Is there anything else you would like to tell us that you think would be important when considering your application?*
Please read and then sign below:
Many factors determine which applicant will be matched with a particular pet. If you are not successful to adopt this pet, it does not mean that you are not considered a good pet owner or that your home is not acceptable. Our goal is to place all animals into homes that will best suit both their individual needs and that of their new family. Please ask for clarification if you have any questions.

I have completed this application truthfully.
Signature*
Signature Date*

MonthDayYear
If you have not received a call and/or email from us within 5 days of lodging your application please ensure that you check your voicemail, spam and junk folders of your phone and email.
THANK YOU FOR TAKING THE TIME TO COMPLETE THIS APPLICATION!
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