Adoption Application

Name: *

Name of others living/caring for animin household (if any):

Address (including City and Zip-code):

Cell:

Home:

Work:

Spouse/Other Cell:

Email *

Best way/time to contact you: *

Place of Employment:

Occupation

Emergency Contact (other than someone living in the home):

Address (including City and Zip-code):

Phone:

Is there a specific animal you are interested in adopting from us? *

Yes
No

If so, which animal and why?

Are all family members in agreement about adopting an animal? *

Yes
No

Do you have children? *

Yes
No

If yes, what are their ages?

Does anyone in your home have pet allergies? *

Yes
No

Do you own or rent? *

Own
Rent

If you rent, what is your landlord's name and telephone number?

Verification required landlord: Date Received: ______________________ HSL Staff Initials: ______________________

Have you already received permission for the animal you would like to adopt?

Yes
No

How long have you lived at the property?

Are you planning to move anytime in the near future? *

Yes
No

Have you owned an animal(s) at this residence in the past? *

Yes
No

If yes, is the animal still at the residence?

Yes
No

If no, reason?

Your veterinarian's name, hospital/clinic, city and phone number (if known):

DOG ADOPTIONS ONLY: You would like a dog for: house pet, guard dog, companion, gift, companion for another dog, or other (please explain):

DOG ADOPTIONS ONLY: How will your dog be confined to your property (please include all that apply)? In the house; in a crate or kennel; in a fenced yard; on a chain; in a garage; on a patio; other...

CAT ADOPTIONS ONLY: You would like a cat for: house pet, mouser, companion, gift, companion for other pet, other (please explain):

CAT ADOPTIONS: Will this cat be allowed outdoors:

Yes
No

CAT ADOPTIONS ONLY: Do you plan to have this cat declawed?

Yes
No

Have you ever adopted an animal from HSL? *

Yes
No

If yes, when?

Do you have any other pets now? *

Yes
No

If yes, how many?

Are they indoor or outdoor pets?

Name(s) / Breed(s) / Age(s)?

Are they spayed/neutered?

Yes
No

If no, reason?

Are they current on vaccinations?

Yes
No

Onsite pet visit completed: Yes____ No____ N/A:_____ Date:____________ Visit outcome:____________________________________

Have you ever had to give up an animal before? *

Yes
No

If yes, reason?

Do you have a yard?

Yes
No

If yes, is it fenced?

Yes
No

Where will your pet be kept during the day? And at night? *

How many hours will this animal spend alone each day? *

How long do you feel an animal should be given for an adjustment period?

Are you willing to work with a new pet on any issues he or she may have? *

Yes
No

What behaviors would be unacceptable to you? *

What actions would you take to correct these behaviors? *

Excluding your death, what conditions or circumstances would cause you to give up an animal? *

Are you prepared to provice for your animal's continued health care, including proper diet, annual examinations, vaccinations and other treatment?

Yes
No

Do you understand the importance of getting your pet spayed or neutered and agree to do so if necessary according to the legally binding adoption contract? *

Yes
No

Additional questions or comments:

Adopter's Initials: *

Please complete and submit the form below or print, fill in and send in the paper forms

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