Your Name

First Name

Last Name

Your Address

Address 1

Address 2

City

State / Province

ZIP / Postal Code

Your Email Address

Your Primary Phone Number

Alternate Phone Number

Email List

Yes, add me to the HSHV email list for the latest promotions and updates from HSHV.

Birthdate

Date

Driver's License Number

Emergency Contact Name

First Name

Last Name

Emergency Contact Phone

If you selected other, please type the species here:

If there's a specific animal you had in mind, please write his/her name here:

Please Describe Personality and Behavior Preferences for the Animal(s) You are Interested in Adopting:

What kind(s) of traits are you looking for in a dog?

How do you feel about mouthing or rough play?

Definite No

Can Train

When I am not home the dog will spend time

In a crate in the house

Loose in the house

Confined in one room

Other

If selected other, please specify where:

How many hours a day does this pet need to be alone?

What kind(s) of traits are you looking for in a cat?

How do you feel about mouthiness or rough play?

Definite No

Maybe

Can Manage this Behavior

Please tell us about your household:

How many people live in your home?

Are any of these people children?

Yes

How many children are in your household?

Please list the ages of the children in your household.

Have you owned any pets over the past few years?

Yes

Please tell us about your pet history over the past few years.

Meet your match!

Adoption application

Your Name

Your Address

Emergency Contact Name

Please Describe Personality and Behavior Preferences for the Animal(s) You are Interested in Adopting:

Please tell us about your household:

We will review the animal's medical history and behavior notes with you. Please let us know if there are any other topics you would like to discuss.

Have questions or concerns?