Adoption Application

Name

Address

City

State

Cell Phone

ZIP

Home Phone

Work Phone

Date of birth:

Do you work or attend school?

Work

Attend school

Both

Unemployed

If work, who is your employer and how long have you worked there?

Do you live in a:

House

Condo

Apartment

Mobile Home

Do you own or rent?

Own

Rent

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

Does your landlord allow pets?

Yes

Unsure

Are there any pet restrictions from your landlord or subdivision (i.e. - breed, size/weight, number of pets, etc)?

Which pet are you interested in?

What type of personality do you want in a new pet (i.e. - playful, laid-back, affectionate, calm, independent, etc)?

Does everyone in your household know and accept the fact that you are considering adopting a new pet?

Yes

Unsure

Number of adults in household:

Number of children in household and ages:

Does anyone in the house have allergies to animals?

Yes

Unsure

Do you have a fenced yard?

Yes

How high is the fence?

Do you plan to move soon?

If you move in the future, what would you do with your pet?

Who will be the pet's primary caregiver?

What type of food do you plan on feeding your pet?

Are you aware of crate training for dogs?

Have you ever house-broken a puppy or dog before?

Where will your new pet sleep at night?

How much time will you spend with your new pet daily?

How many hours will your new pet be home alone?

What will happen if your new pet grows up to be larger than expected?

If your pet has an "accident" in the home, what type of correction do you plan to use?

What circumstances would lead you to give up your pet?

If you had to give up your pet, what would you do with him/her?

If applying for a dog, how will you supervise his/her outdoor activity?

If applying for a cat, would you allow him/her to go outside?

If you do allow the cat to go outside, how will you supervise his/her safety?

If applying for a cat, are you aware of proper litter box care?

Select why you would like to adopt a pet from us:

If other, please explain.

What pets have you had in the past 5 years?

Do you still have these pets?

If so, where do they spend most of their time?

How are your current pets confined?

Are your current pets spayed/neutered?

Yes

Unsure

Are your current pets up-to-date on vaccinations?

Yes

Unsure

Who is your current veterinarian (name and phone number)?

When and where were your pets last vaccinated (we check vet references)?

Do you understand that a pet can be an 18 year commitment, must be regularly exercised, groomed and vetted, and may cost $300-500 annually for care?

Yes

Do you realize that your new pet may take anywhere from 2 weeks to 2 months to become adusted to its surroundings, and may require extra patience and training during this stressful time?

Yes

Have you adopted a pet from Heatland Humane Society before?

Yes

Unsure

If yes, how long ago did you adopt your pet?

If yes, do you still have this pet(s)?

If no, what happend to your pet?

Do you realize that, if at any time, things do not work out with your new pet, that you should contact Heartland Humane Society to make arrangements to return the pet?

STRAYS: I understand that no information is available about the prior history, behavior, or temperament of this dog/cat. (please initial)

Character reference and phone number.

Additional comments:

By submitting this form, I certify that the information I have given on this application and in my interview with the shelter representative is true and accurate, and I recognize that any misrepresentation of facts may result in my losing the priviledge of adopting a pet. Neither myself, nor any other person living in my household, has ever been convicted, either in the adult or juvenile court system, of any act of animal cruelty or neglect. In addition, I understand that Heartland Humane Society has the right to deny my request to adopt an animal for any reason, and I authorize investigation of all statements in the application. I understand that my pet should see a veterinarian within 5 days after adoption. I further understand that this application is the property of Heartland Humane Society. We would like to remind you that filling out a Pre-Adoption Application is not an Adoption Agreement. Heartland Humane Society reserves the right to deny any application for adoption. We want to ensure that all completed adoptions are in the best interest of both the animals and the family. (please initial)

Heartland Humane Society of Missouri

A Foster Based Animal Rescue Group

Adopting a Pet

Adoption application