Adoption Application - Universal - Updated 12/2014 Thank you for your interest in adopting an animal! To help find the best match possible, please complete this form. First Name * Last Name * Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Address Primary Phone * Alternate Phone Email * Driver's License Number Birthdate * Emergency Contact Name Emergency Contact Name First Name First Name Last Name Last Name Emergency Contact Phone Please tell us about your household. How many people do you have in your home? * How many of those people are children? * If you do have children in your home, please list their ages. Which of these applies to your home? * Own Rent Our home is: * Active Quiet/Low-key Somewhere in between Do dogs frequently visit your home? * Yes No We are adopting for * Our family Our child(ren) Another family member Companion for another pet Guard dog Barn cat Outdoor pet Please tell us about your pet history over the past few years. Pet's Name Species/Breed Age Where is your pet now? Currently in homeDeceasedLiving elsewhere plus Add another pet minus Remove this pet Please tell us about the pet you'd like to adopt. If there's a specific animal you had in mind, please write his/her name here: The pet should be A must Doesn't matter Easygoing or Laid back A must Doesn't matter Active or Energetic A must Doesn't matter Loves other animals A must Doesn't matter Okay being alone A must Doesn't matter Quiet A must Doesn't matter Declawed A must Doesn't matter Definite No Can Train Mouthing/Rough Play Definite No Can Train How many hours per day does this pet need to be alone? * When we are not home, our pet will spend time * In a crate in the house Loose in the house Confined in one room In the yard Other:Other: We'll review the animal's medical history and behavior notes with you. Please let us know any other topics you'd like to discuss. I'd also like to discuss Acclimating this pet to our home Introducing this pet to our resident pets House and crate training Basic training Toys & fun Finding a pet trainer Preventatives (i.e., for heartworm, flea & tick) Moving with pets Introducing pets to a baby Nail trimming/Tips for managing scratching - Yes, add me to the HSHV email list for the latest promotions and updates from HSHV. Submit If you are human, leave this field blank. Δ
