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
Media Outlet or Channel (news)
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
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