Small Animal Adoption Application
Please note: when applying to adopt, please only complete ONE application form per household.
Name of animal(s) interested in adopting
*
Applicant Information
Applicant’s Name
*
Partner’s Name
Address
*
Apartment/Unit Number
City
*
Postal Code
*
Primary Phone Number
*
Format: (000) 000-0000.
Primary Phone Type
*
Home
Cell
Work
Secondary Phone Number
Format: (000) 000-0000.
Secondary Phone Type
Home
Cell
Work
Partner's Phone
Email Address (if you do not have an email, please put noemail@noemail.com)
*
example@example.com
Emergency Contact Information
Please list an emergency contact that does NOT live in your household.
Emergency Contact’s Name
*
Relationship to Applicant
*
Phone Number
*
Format: (000) 000-0000.
Household Information: Applicant
Complete the information for yourself below.
Are you 18+?
*
Yes
No
Please specify your age:
*
What is your occupation?
*
Working
Student
Other
Who will be the primary caregiver for this pet?
*
Does anyone in your household show signs of allergies to the type of animal you are applying to adopt?
*
Yes
No
Sometimes
Unsure
What type of dwelling do you currently live in?
*
House/semi-detached/townhouse
Condo/apartment
Other
Household Information: Other Household Members
List the names, ages, relationships, and occupations of each person living in your household.
Person 1: First & last name
Person 1: Are they 18+?
Yes
No
Person 1: Age
Person 1: Relationship to applicant
Person 1: Occupation
Working
Student
Other
Person 2: First & last name
Person 2: Are they 18+?
Yes
No
Person 2: Age
Person 2: Relationship to applicant
Person 2: Occupation
Working
Student
Other
Person 3: First & last name
Person 3: Are they 18+?
Yes
No
Person 3: Age
Person 3: Relationship to applicant
Person 3: Occupation
Working
Student
Other
Person 4: First & last name
Person 4: Are they 18+?
Yes
No
Person 4: Age
Person 4: Relationship to applicant
Person 4: Occupation
Working
Student
Other
Pet Ownership
Please list current and previous pets, including pets that have passed on. Select the appropriate response for each.
Pet 1: Name
Pet 1: Type & Breed
Pet 1: Age
Pet 1: Sex
Female
Male
Pet 1: Spayed/ Neutered
YES
NO
Pet 1: Declawed
YES
NO
Pet 1: Indoor/ outdoor
IN
OUT
BOTH
Pet 1: Where is the pet?
Still own
Deceased
Other
Pet 1: Ownership
Childhood pet
My pet
Other
Pet 2: Name
Pet 2: Type & Breed
Pet 2: Age
Pet 2: Sex
Female
Male
Pet 2: Spayed/ Neutered
YES
NO
Pet 2: Declawed
YES
NO
Pet 2: Indoor/ outdoor
IN
OUT
BOTH
Pet 2: Where is pet?
Still own
Deceased
Other
Pet 2: Ownership
My pet
Childhood pet
Other
Pet 3: Name
Pet 3: Type & Breed
Pet 3: Age
Pet 3: Sex
Female
Male
Pet 3: Spayed/ Neutered
YES
NO
Pet 3: Declawed
YES
NO
Pet 3: Indoor/ outdoor
IN
OUT
BOTH
Pet 3: Where is pet?
Still own
Deceased
Other
Pet 3: Ownership
My pet
Childhood pet
Other
Pet 4: Name
Pet 4: Type & Breed
Pet 4: Age
Pet 4: Spayed/ Neutered
YES
NO
Pet 4: Sex
Female
Male
Pet 4: Declawed
YES
NO
Pet 4: Indoor/ outdoor
IN
OUT
BOTH
Pet 4: Where is pet?
Still own
Deceased
Other:
Pet 4: Ownership
My pet
Childhood pet
Other
1. Have you ever had to give up an animal? If so, please explain the circumstances
*
2. In order to feed, provide medical and daily care for my new pet, I am prepared to spend the following per year:
*
3a. Please list the names of the veterinary clinics your pets have seen.
*
3b. When were their last vaccinations? (month and year)
*
3c. How often do your current pets go to the vet?
*
4. Under what circumstances would you take your new pet to the vet?
*
5. Please describe the type of housing accommodations you will provide for your new pet (eg. size, type of bedding, toys etc)
*
6. I would like my new pet to be (check all that apply):
*
In the backyard supervised
In an outdoor enclosure
Free roaming outdoors
Allowed on the balcony
Inside, in its cage
In the garage/barn
Given free access to the house
Other
7. Where will your new pet's enclosure be kept?
*
8. I plan to spend time and socialize my new pet in the following ways:
*
9. I would like my new pet to breed:
*
Yes
No
Unsure
10. I plan to feed my new pet the following:
*
11. What behaviours are you NOT willing to work with, or situations that would cause you to return this animal? (check all that apply)
*
Unable to litter box train
Medical issues
Not social; spooks easily or hides
Doesn't get along with other animals
Destructive
High energy, too time consuming
High maintenance
Rough play; biting
Requires too much space
Too time consuming
Messy or strong odor
Vocal
Willing to work with all
Other
12. Please check the topics you would like more information on:
*
Litter box training
Diet
Proper handling
Housing
Grooming
Exercise requirements
Pet-to-pet introductions
Rough play/nipping
Common medical issues
Destructive behaviour
Pet proofing the home
Other
13. If I move, I will
*
Take it with me
Find it a new home
Give it to a family member
Surrender it to an animal shelter
14. We'd love to know! How did you first find or hear about the animal you're interested in adopting?
HSOMH Website
HSOMH Facebook Page
HSOMH Instagram Page
HSOMH TikTok Page
HSOMH Newsletter
Facebook Group
Google Search
PetFinder
Referred to by Family or Friends
Walk-in Visit at the HSOMH Shelter
Community Event
Barkin' Bin Thrift Store
Other
Acknowledgement
By signing below:
I certify that I am at least 18 years of age and have the knowledge and consent of all adults living in my household.
I certify that the information I provide on this application is true and complete. I authorize the investigation of all stat
eme
nts contained on this
application and understand that the Humane Society of Oakville, Milton & Halton has the right to deny my request to adopt an animal.
I understand that this application is the property of the Humane Society of Oakville, Milton & Halton.
I understand that the Humane Society of Oakville, Milton & Halton may contact my veterinarian and I authorize access to any records held
by
that office in
regards to my current and past pets.
I would like to receive electronic communications from the Humane Society of Oakville, Milton & Halton, 445 Cornwall Road, Oakville, On. 905-845-1551. shelter@omhs.ca. I understand that I can unsubscribe at any time using the SafeUnsubscribe button at the bottom of every email. I would like to receive emails to the following email address:
example@example.com
Signature
*
FOR OFFICE USE ONLY :
Date
*
/
Month
/
Day
Year
Date
Animal Name(s)
SB#/Location
Adoption Phone Meeting
Adoption Pick-Up
Drivers Licence
Completed Review
SB Check: Y / N Confirmed Address: Y / N
Continue
Continue
Should be Empty: