Application for Adoption

Adoption Application:

Name:

Age:

Occupation

Address:

City:

State:

Zip Code:

Home Phone:

Work Phone:

Cell:

Email:


Co-Applicant:
Name:

Occupation

Age:


What is the name of the animal you are interested in ?:

This is a

May a representative of the HSNWGA visit your home for an inspection by appointment?
 Yes
 No
Please check any of the following reasons for adopting this pet:

 Family Pet
 Child's Pet
 Watchdog
 Barn Cat/Mouser
 Companion
 Hunting Dog
 Guard Dog for Business
 Gift
 Companion for other pet
 Other:


Please indicate where you live:

 House
 Apartment
 Townhouse
 Mobile home in park
 Mobile home on property
 Other
Do you:


Do you have a fenced yard?


How high and what type? (if no, type n/a):

How many times have you moved in past 7 years?


If you rent….
What is the Landlord’s/Complex’s phone number?

How much is the pet deposit?


the future……
Do you foresee any major changes in your life in the next 5 years,

 Marriage
 Child Birth
 College
 Health problems due to age
 Other

Number of adults in household?

Do children live in the home? :
 YES
 NO
What gender and age(s) (if no, type n/a):

Does anyone in the household smoke?


Do any family members have allergies?:


Explain allergies: (if no, type n/a):


Number, type and age of pets currently in household:
Dogs:

Cats:

Do any of your current or did any of your past pets live primarily outdoors


If yes, describe pet:

Were all previous pets Spayed or Neutered?



Do you know what Heartworm disease is and how to prevent it?


Do you use Heartworm prevention with current pets?


How often is it administered?

How do you plan on preventing Fleas and Ticks?

If adopting a dog, how will you handle destructive behavior?

What procedures will you use for Housebreaking?

If adopting a cat, how will you handle scratching/destructive behavior?

What is you veterinarian’s name and phone number?

Please describe what happened to each of your past pets? (given away, put to sleep, died of old age, etc)

How many hours a day will the pet be left home alone?

Where does you current pet(s) stay when home alone?

Where will your new pet stay when home alone during the day?

Where do your current pets sleep at night?

Where will your new pet sleep at night?

What % of time will new pet spend indoors?

Do you have a pet door?


Have you always kept an ID tag with your phone number on your pets?


Under what circumstances do you think it’s OK to leave a dog outside, alone and unsupervised in a fenced in area?

What circumstances, in your mind, justify giving up a pet?
 Moving
 New baby
 Divorce
 Not getting along with other pets
 Getting out of fence
 Behavioral problems
 Children lost interest
 If it gets to big
 Becomes too time consuming:
 Shedding
 Allergies
 Housebreaking problems
 Medical problems
 Aggressive behavior
Other:

Have you ever given up a pet or had a pet that didn’t work out?


If so, please explain the circumstances and what happened to the pet:

Have you ever looked at or applied for a pet with another rescue group?


If so, how long ago?

Did you adopt?


Which shelter/rescue group?

If you date or marry someone who does not like or want your pets, what would you do?


What type of food will you feed your new pet?
 Dry
 Canned
Brand name:

Has a dog, puppy, cat or kitten died on your premises in the last six months?


Explain circumstances

Please list the names, address’ & phone numbers of two references: