DIRECTIONS: ENTER YOUR RESPONSE TO EACH OF THE QUESTIONS BELOW: REVIEW YOUR RESPONSES AND MAKE CHANGES WHERE APPROPRIATE: TAP THE "INSERT RECORD" ONLY WHEN YOU ARE SATISFIED WITH YOUR RESPONSES. THIS FORM DISAPPEARS AND CREATES YOUR RECORD AND YOU WILL BE REQUIRED TO RE-CREATE THE FORM IF YOU "INSERT RECORD" PREMATURELY. THANK YOU FOR YOUR COOPERATION.
App_type:
dog
Dog That You Wish to Adopt:
First Name:
Last Name:
Home_phone:
Work_phone:
Cell:
Email:
Occupation:
Address:
Address_2:
City:
State:
Zip:
Under_18:
Do we have your permission to visit your home using the address you provided above?
Yes
No
Have you applied for an animal previously through the HSFC?
What was the date of that Application?
What was the outcome of that application?
List the animals you have owned previously; Provide two examples below:
What breed was it?:
Name?
Age?
Sex?
Spayed or Neutered?
How long did you own that animal
Where was it housed?
Do you still own that animal?
What finally happened with that animal?
What type was the second animal?
Name?
Age?
Sex?
Spayed or Neutered?
How long did you own that animal?
Where was it housed?
Do you still own that animal?
What finally happened with that animal?
Please list your Vet's Name
Vet's Phone Number
PLEASE UNDERSTAND THAT YOU SHOULD CALL YOUR VET TO INFORM HE/SHE THAT AN HSFC VOLUNTEER WILL BE CALLING TO VERIFY RECORDS REGARDING THEIR TREATMENT OF YOUR PET
Do we have your permission to call your vet?
Yes
No
Why do you want to adopt an animal:
Do you own or rent your home?
Do you have an enclosed fence; if so, tell us about it:
Where do you live?
House
Apartment
Duplex
Condo
Townhouse
With Parents
Please detail any restrictions on pets such as weight, type or number of pets
What is the name of your condo/apt?
What is the Manager's Name?
What is the Manager's Phone No?
YOU SHOULD INFORM YOUR APARTMENT MGR THAT AN HSFC VOLUNTEER WILL BE CALLING TO DETERMINE IF THEIR ARE ANY BREED OR SIZE RESTRICTIONS AT YOUR FACILITY!
Do we have your permission to call your manager?
Yes
No
How many Adults in your Home?
How Many Children?
What are their ages?
Is someone at home during the day?
Is someone at home at night?
Do you think that dogs should live outside?
If so, why?
Will this dog be going outside for more than recreation?
If so, why?
Who will have responsibility for feeding?
Exercise Responsibility?
Grooming Responsibility?
Training Responsibility?
Who will have responsibility for the pets expenses?
How were you referred to our Humane Society?
This dog may require a spay/neuter surgery, rabies vaccine or other medical expenses following adoption. Are you prepared to take on these expenses?
Because it is very stressful for a dog to go from home to home, we hope to place each one in a caring home for the rest of its life, which could be up to 20 years. Are you prepared to make this commitment
What will happen to the dog if you have to move?
In an effort to ensure the dog’s lifelong well-being, we screen our adopters very carefully and sign a legal contract with them. If at some point, you can no longer care for the dog we require that you return it to us. This way, the dog may be re-adopted to other qualified applicants and once again be protected by a legal contract. How do you feel about this?
This dog may take several weeks or months to fully adjust to you, your home and your animals. How would you ease the adjustment?
How will you exercise the dog?
What behavior to you regard as unacceptable?
How would you handle these behaviors?
How would you correct or discipline this dog?
Do you believe in spaying or neutering?
If so, why?
Are your current pets properly licensed?
Have they been vaccinated?
If accepted, when would you like to take your pet home?
List those subjects you would like to learn more about?
List the types of dog you are interested in?
Signature:
Date_signed (xx/xx/xxxx):
I understand that you will be contacting my veterinarian for the vaccination and health history of the pets I currently own or have owned in the past. I release, through my signature on the application, my veterinarian to provide that information to you. I am aware that prior to placement of a pet from the HSFC, my currently owned pets, for their protection, must be up to date on needed vaccinations.
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