Name of the Dog or Cat you are applying for:
Why do you want to adopt the Dog or Cat you are applying for?
   
PERSONAL INFORMATION  
Name(s):
Address:
City:
State, Zip:  
Home Phone:
Work Phone (if none, enter None):
Cell Phone (if none, enter None):
Email Address:
Your  Age:
How many other adults live in your home?
How many children live in your home?
What are their ages, if appl.?
Your Occupation(s)and Name of Business:
   
HOUSEHOLD INFORMATION  
Do you own or rent?
If you rent, provide Landlord Name & Phone Number:
Do you have a securely fenced yard?
What type of fence do you have?
What is the height of your fence at the LOWEST point?
Do you plan on moving in the near future?

Please describe any current PETS that you have:

Species (Dog,  Cat, Bird, etc) Breed Sex Spayed/Neutered Current on Vaccinations
*Please use comment section at the bottom to add any other additional pets you currently own.
 
Have you had any pets in the past?
   
PET CARE INFORMATION  
Please provide your vet's name and phone number:
If no current vet, please provide your past vet's name and phone number:
   
If Applying For A Dog:  
How many hours a day will this adopted dog be left alone? 
Where will this adopted dog stay during the day?
Where will this adopted dog stay during the night?
Will you be able and willing to regularly exercise this adopted dog?
Please describe your method of exercise:
   
If Applying For A Cat:  
Where will the adopted cat stay during the day?
Where will the adopted cat stay during the night?
Will the adopted cat be indoors or outdoors?
Have you ever declawed a cat?

These Questions Apply to both dog and cat applicants:

If for some reason you are not able to care for this pet in the upcoming future, what will you do with this adopted pet?
Have you ever given a pet to a shelter/humane society?
If YES, what was the reason for giving up the pet?
 

PERSONAL REFERENCES

  

List two non-relatives who can verify that you are a responsible, reliable and caring person.

Name:
Phone Number:
Name:
Phone Number:

Is there anything else you would like us to know about you that may help in approving your application?

Comments or Questions:


I certify that the information is true and accurate to the best of my knowledge and that I understand that providing any false information can be cause for denial of my application or future forfeiture of the adopted pet. Leaving any questions blank or not filling out this form completely can be cause for the application to be discarded or denied.

By signing this contract I agree: 

To consent to an employee of HELP FOR HOMELESS PETS to come to my home;

 To inspect/prove that the above statements are true.

 To find that my home & I am suitable to adopt this animal. 

 To call the references listed for character of perspective adoptive person/family.


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