Adopter Information: First Name: Last Name: Address: City: State: Zip Code: Phone: Cell: Email: Married: Yes No Children: Yes No Children's Ages: Have they been exposed to animals? Yes No Does everyone in the household want this animal? Yes No Does anyone in the household have an allergy to animals? Yes No Do you share your home with animals at this time? Yes No Have you had animals in the past: Yes No Were they spayed or neutered? Yes No Housing: Housing: Own Rent Housing Type: Apartment Mobile Home Condo House Other How long at current residence: If renting, landlord's name AND phone number (required to process application): Approximately how much ground do you have? Size of fenced in area: Fence Type: Employer: Employer: Amount of time at this employer: Phone: Hours per week: Spouse's Employer: Amount of time with this employer: Phone: Hours per week: Current Pets: Name: Type: Feline Canine Spayed or neutered: Yes No Breed: Age: Name: Type: Feline Canine Spayed or neutered: Yes No Breed: Age: Who is your veterinarian for the animals listed above? What is the phone number for the vet's office? Past Pets: Name: Type: Feline Canine Spayed or neutered: Yes No Breed: Age: Name: Type: Feline Canine Spayed or neutered: Yes No Breed: Age: General Questions: Why do you want to adopt this animal? Are you planning on any physical alterations? Declawing Ear cropping Tail Cropping None Will the animal sleep inside the home? Yes No If no, where will the animal sleep? How much time will you spend with the animal daily? How much time will the animal spend alone daily? What type of food do you plan to feed this animal? If adopting a feline, do you plan to feed canned food as well as dry food? Yes No If adopting a canine, how do you plan to housebreak the dog? What would you do with this animal if you had to move from your present home? How long do you plan to keep this animal? Applicant's Signature: I understand that this application does not guarantee an adoption. I agree that HELP the Animals has the right to refuse an adoption for any reason. By putting my initials here, I acknowledge that I have read the above statement Drivers license number: State: Animal You Would Like to Adopt: Please fill out as much information as is known. If submitting with no animal in mind, fill out as many preferences as possible. Animal Type: Dog Cat Animal Name: Breed Description: Age: Sex: Male Female Unknown No Preference
