Thursday 20 June 2013
Type of pet you want to adopt: ---catdog
Why this pet?
Full Name* Email*
Street Address* City*
State*---AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareD.C.FloridaGeorgiaIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming Zip code*
Phone number* (daytime) Phone number (evening)
Are you 21 or older? ---yesno If not, who will be signing the foster agreement?
Number of adults in the home ---12345678910 Number of children in the home ---012345678910
Ages of the children in the home
What type of home to you live in? ---houseapartmentcondomobile-homeother If other, please specify
Do you rent or own ---rentownlive with parentsother If other, please specify
Do you have written permission from your landlord to have pets in your home? ---yesnoN/A
May we contact your landlord/parents? ---yesno
Parent/landlord's full name Phone Number
Would this be your first pet? ---yesno Explain
Number of pets in your home ---012345678910
Current pets (name, age, sex, breed)
What happened to pets you no longer have? If deceased, state cause and circumstance)
Have you ever applied to adopt a pet from HFA before? ---yesno If yes, when? (MM/YY)
Have you ever asked HFA to take an animal for you? ---yesno If yes ,explain
What brand of food do (did) you feed your pet(s)?
How do you plan to introduce the new pet to your current pet(s)?
Will you spay/neuter your pet if not already done prior to adoption? ---yesnomaybe
Why do you want to adopt this animal? (select all that apply)
companion companion for other pet house pet hunting barncat/ mouser other
If other please specify
How will your new pet spend its days? (select all that apply)
indoors outdoors crated tied outside basement garage porch yard cage barn locked in room in doghouse in person's bed
If you go away who will care for your pet?
Is someone home during the day? ---yesno Explain
Are you willing to take responsibility for this pet until he/she dies of old age or illness (sometimes 10-20 yrs) even if your situation change or if you have to move? ---yesnomaybe
Does any member of your household have an allergy to animals ---yesnodon't know
For cats only
Will you have your cat declawed? ---yesnomaybe Are your current or previous cats declawed? ---yesnoN/A
What is your opinion of declawing cats?
Where will you keep the cat? ---insideoutsideboth Explain
For dogs only
Do you have a completely fenced-in back yard? ---yesno
Fence height Fence type Does the fence have a gate? ---yesno
How will you exercise the dog?
If you drive in a pickup truck, would you allow the dog to ride in the back? ---yesnoN/A
Vet name Phone number
Names of pets under vet care
Note: This part is optional if you have a vet reference.
Name Phone number
How long have you known him/her? Type of reference ---colleaguefriendfamily memberother
If "other" please specify
I agree to allow HFA to visit my home by appointment as part of the application process. I give my veterinarian permission to disclose information about my pets, my account, and myself. If I adopt a pet, I will spend the time and money necessary to maintain its health and well-being. I will spay/neuter the pet if it has not already been done prior to adoption. I attest that all the information provided in this application is true and complete to the best of my knowledge. If any of the information changes, I will notify HFA as soon as I can.
Check here if you accept these terms.
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