Adoption Application
Basic Information
Name
*
First Name
Middle Initial
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Place of Employment or Main Source of Income
*
Are you a veteran or active duty service member?
*
Yes
No
Your Residence
What type of home to you live in?
*
Please Select
House
Apartment
Condo
Mobile Home
Dorm
Farm
Do you rent or own your home?
*
Rent
Own
Other
If you rent, please provide your Landlord's Name and Phone Number. If you are not listed on the deed, please provide the deed holder's information.
*
Some cities, communities, and property managers enforce pet restrictions (breed, species, size, etc). Do any of these restrictions apply to your situation?
*
None
Weight Restriction
Breed Restriction
Declawed
Registered emotional support animal
Other
Please list the first name, middle initial, last name, and birth date of any additional adults living in the home over the age of 18, including spouse/significant other. If none, please type "None" in the box below.
*
Have you or anyone in your household been charged with OR convicted of any type or assault? If yes, please explain below. If no, type "No" in the box below.
*
Have you or anyone in your household been charged with OR convicted of animal abandonment, neglect, or cruelty? If yes, please explain below. If no, type "No" in the box below.
*
Are there any minors under the age of 18 in the home? If yes, please list their ages. If no, please type "No" in the box below.
*
General Questions
Have you adopted from our shelter before?
*
Yes
No
Have you ever been denied adoption from our shelter or any other shelter in the past?
*
Yes
No
If yes, please explain.
Have you ever surrendered a pet to animal shelter?
*
Yes
No
If yes, please explain.
Current Pets
Do you currently have any pets?
*
Yes
No
Please list ALL pets that are currently living in your home. Information to include: Name, Type of Pet, Breed, Age, Sex, Spayed/Neutered.
*
Name of the vet clinic you use?
*
Phone number of the vet clinic you use?
*
Could the records be under any other name? If so, please list the name.
*
Are your pets up-to-date on vaccinations?
*
Yes
No
Vaccination Records (if you have a copy of them, otherwise we can contact your vet office. If the upload doesn't work, please email the copy to staff@almosthomeiowa.com)
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Adoption Info
What type of pet are you looking for?
*
Cat
Dog
Both
Which animal(s) of ours are you interested in? If you aren't sure, just list some qualities you are looking for and we can help match you up!
*
Where will your new pet be kept during the day? Where will it be kept at night?
*
Do you intend to keep this pet inside or outside?
*
Inside
Outside
How did you hear about this pet?
*
Almost Home Website
Petfinder
Facebook
Other
It may take three or more weeks for an animal to adjust into your home (depending on the household). Are you willing to give ample time for the adjustment?
*
Yes
No
What will this pet's primary role in the family be?
*
Companion
Gift for a child
Companion for another pet
Shop/Outside
Cat Only Questions
A cat may live for 12 to 20 years. Are you prepared to make a commitment to this cat for its lifetime?
Yes
No
Do you plan to declaw your cat?
Yes
No
Do you plan to keep your cat inside at all times?
Yes
No
Do you plan to allow the cat to go outside?
Yes
No
Is this cat going to be a barn cat or shop cat?
Yes
No
Terms and Agreements
I am 18 years old or older.
I have made all people in my household aware of my intention to adopt an animal.
I give consent to the Almost Home Adoption Team to contact my landlord (if applicable) and my veterinarian office for vaccination verification.
I give consent for a background check to be completed on myself and everyone 18 and older in my household as part of the application process. I have made everyone in my household aware of this process and they give consent to the background check as well.
By signing my name below, I have read and agree to the terms and agreements above. I understand that Almost Home Humane Society of North Central Iowa has the right to refuse adoption of our animals to any individuals who do not meet our adoption criteria.
*
Date
*
-
Month
-
Day
Year
Date
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