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    Adoption Application

    Uploaded by

    Kris Bunner
    The document is an adoption application for an animal shelter that collects information such as contact details, housing and family details, veterinary references, and questions about the potential care of the adopted pet.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    Adoption Application

    Uploaded by

    Kris Bunner
    55 views2 pages
    The document is an adoption application for an animal shelter that collects information such as contact details, housing and family details, veterinary references, and questions about the potential care of the adopted pet.

    Copyright

    © Attribution Non-Commercial (BY-NC)

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    PDF, TXT or read online from Scribd

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    The document is an adoption application for an animal shelter that collects information such as contact details, housing and family details, veterinary references, and questions about the potential care of the adopted pet.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    55 views2 pages

    Adoption Application

    Uploaded by

    Kris Bunner
    The document is an adoption application for an animal shelter that collects information such as contact details, housing and family details, veterinary references, and questions about the potential care of the adopted pet.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    ADOPTION APPLICATION

    Please Print Clearly

    Date: _______/_______/_______ Animals Name / ID #: ______________________

    Dog □ Cat □ Other □ ________________________

    Male □ Female □ Age_____

    Primary Caregiver’s Name: ______________________________________________

    Street Address: ___________________________________________________________

    City, State, Zip: ____________________________________________________________

    Mailing Address
    (If different than Street Address): __________________________________________________

    Telephone: Please check the one that will be your preferred telephone contact number

    Home □ ( )____________________ Cell □ (______)__________________________ _

    Work □ ( )________________________________________ ____ ______

    E-mail Address : _____________________________________________ __ _

    Housing:

    House □ Apt. □ Other □


    How long at present residence? ______________________

    ► If you rent, please provide dated, written pet permission from the property owner ◄

    Family Information:

    Including you, how many members are in your family and/or household? _____________

    If you have children, or children reside in your household, please list each of their ages:

    1.__________ 2.__________ 3.__________ 4.__________ 5.__________

    VETERINARIAN INFORMATION:

    A call to your veterinarian will be placed by a HSOMC representative for a reference check
    in order to verify that your past and present pets have been kept up to date on
    preventative health care, including sterilization. This is a requirement.

    Application-ADOPTION Page 1 of 2
    A home visit may be required before the adoption process can be finalized. It is important
    that any other pets you have are given a chance to interact with the potential new pet in
    order to see if they will be compatible. If any issues need to be addressed prior to
    finalizing the adoption process, we will discuss those options that may help minimize
    stress.

    Vet’s Name and/or place of Business: _________________________________________________

    __________________________________________________________________________________
    Address City State Zip

    Telephone No.: ___(________)________________________________________________________

    Please list any other pets you presently have, or have had, in the past 10 years that you have
    personally owned:
    If you have never personally owned a pet, please list the names and phone numbers of 3 personal
    references, only one of which may be a relative.

    Name Type of Pet Age Spay/Neutered Time Owned

    DOG:

    On average, how many hours per day will the dog be left alone? ____________________

    Where will the dog be kept during the day or within the hours that nobody is home?

    Answer:______________________________________________________________________________

    Would you consider taking your new dog to obedience training? Yes □ No □
    Dog and CAT:
    This animal will primarily be:

    Indoor □ Outdoor □ Both □


    General information:

    Who will be responsible to care for your new pet on a daily basis?

    Answer:_______________________________________________________________________________

    Have you previously adopted a companion from a shelter or rescue group?

    Yes □ No □ Organization name?_________________________________

    Thank you for taking the time to fill out this application.

    Please sign and return to:

    HSOMC Or return to [email protected]


    P.O. BOX 1034
    MIDLAND, MI 48641-1034

    Signature of Applicant______________________________________________
    Application-ADOPTION Page 2 of 2

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