Adoption Form

Adoption Application

Please complete and submit the following information. We will review and contact you as soon as possible.

Thank you for your interest!

First Name

Last Name

Address

City

State

Zip

Phone/Cell Number

Alternate Phone

Your age

What animal are you interested in?

Have you ever had a pet?

Y N

Do you have a pet now?

Y N

Please provide details about current/past pets

Do you own or rent?

Years at current address?

What type home do you live in?

Breed/weight restrictions?

Yes No

If your rent, please provide your landlord's name and contact information:

Please describe any restrictions. If you own, but live in a condo or townhouse we will require a copy of your association's pet rules.

Do you have a private yard?

Yes No

Is your yard fenced?

Yes No

Describe type and height of fence

Who else lives in your home?

Who will be the primary caretaker?

Does everyone agree to adopting?

Yes No

Does anyone in the household have allergies or asthma

Yes No

How many hours a day will your pet be alone?

Who will care for your pet if/when you travel?

Current/Past Veterinarian

Vet Phone #

Have you ever adopted from an animal shelter or rescue group before?

Yes No

Have you ever returned an animal to a shelter or rescue or re-homed one?

Yes No

Please provide two personal references

Are you willing and able to provide adequate diet and exercise, regular veterinary care as may be required, house training if needed, and agree that your pets are not kept outside either chained up or allowed to free roam?

Yes No

Please add any other information

I understand that HHART will request a donation for adoption; that these donations are used to defray the medical costs for the adopted animal including exam, immunizations, spay/neuter and other treatment as may be needed, and is nonrefundable under any circumstances.

Yes No