Adoption Application

This questionnaire is intended to be a guide to help you think about all the ways a rescued pet will impact your life and also to determine if you are a suitable match for one of our rescued pets. All of the questions concern various aspects of pet ownership that should be given serious consideration before deciding to share your life with any animal. The information you provide on this application will help us to find the most suitable pet for your family. Please complete every question.

Incomplete applications will not be considered.

First Name:

Last Name:

Address:

City:

State

Zip

Driver's License #:

Daytime Phone #:

Evening Phone #:

Alternate Phone #:

Email:

Your Age:

Employer:

Spouse/Significant Other:

Spouse/Significant Other Age:

Spouse/Significant Other Employer:

How many children do you have living at home?

Please list the ages of children living at home:

Does anyone else live in your home?

Does anyone in your home have allergies or asthma?

Which of the following best describes your living situation?

Do you own or rent?

If you rent, Please provide your landlord's name, address and phone number (this must be complete and we will verify):

Renters must provide landlord statement indicating that a pet may live on the premises.

How long have you lived at this address?

If less than 2 years, previous address and landlord:

Do you have a fenced yard?

Please describe:

If you don't have a fenced yard, are you prepared to leash walk?

What will happen to your pet if you must move unexpectedly?

Where will you keep your pet if you go on vacation or in the case of an emergency?

Is there a particular pet you are interested in?

Name of Pet:

On a typical day in your home, a pet will be alone:

Your home is usually:

What do you expect your monthly expenses to be for your new pet?

Who will be the primary caretaker for your new pet?

Where will the pet be kept?

Where will the pet sleep at night?

If necessary, would you be comfortable doing some training or attending obedience classes with your pet to correct behavioral issues or improve manners?

Under what circumstances might you want to return your pet? (Examples: Marriage, new baby, divorce, behavior issues, financial stress, moving, job change, etc.)

How long will you give your new pet to adjust to its new surroundings?

Would you prefer a dog that is:

Would you prefer a male or female dog?

Would you prefer a cat that is:

Would you prefer a male or female cat?

Do you currently have other pets?

If yes, please describe each pet in detail (species, age, breed, sex, spayed/neutered, personality):

If you have pets that are not spayed or neutered, please explain why:

Have you ever taken a pet to a shelter, sold a pet, or found a new home for one?

If yes, please explain why:

Veterinarian Name and Telephone Number:

Animals seen at that vet clinic:

Are your pets current on vaccinations?

If you own dogs are they on heartworm preventive medication?

Please list all the animals you have owned in the past 5 years and what happened to them:

Please list the names and telephone numbers of 2 personal references who are not related to you.

Name

Phone

Any Additional Comments?

How did you learn about HSUC?

Signature