Adoption Application


All sections must be filled out in order to be considered as a potential adopter. You may also download a copy of the Adoption Application HERE.


Contact Information
First Name
 Last Name
Address
 E-mail
City
 State
 Zip
Home Phone
 Cell Phone
 Work Phone
Employer
 Employer's Address
Date of Brith
 DL or ID Number
 State
Personal
Information

Marital Status:
Single
Married
Separated
Divorced
Widow
 Housing
Information

Do you currently:
Rent
Own
Live with Relatives
Other
Details
 Family
Information

Are there children in the home?
No
Yes
Ages
Pet History & Animal Care Background

Have you ever owned a pet?
No
Yes

If yes, please list any pets you have owned that are not currently living with you:
BreedHow long did you have the pet?What happened to the pet?


Do you currently have pets in your home?
No
Yes
How many?

NameBreedSexAgeSpay/
Neuter		Current
Vacc.


Have you ever surrendered a pet to an animal shelter or rescue organization?
No
Yes
If yes, please explain the situation:


Is anyone in the home allergic to pets or pet hair?
No
Yes
If yes, how will you cope with the issue?
Adoption Plans

What pet are you interested in?

Will this pet be an indoor or outdoor pet?
Indoor Pet
Outdoor Pet
Why are you interested in this particular animal?
How many hours a day will you be able to spend with this pet?
Where will the pet stay when you are at work or away from home?
Where will the pet sleep at night?
Should something happen and you had to relocate or could no longer care for your pet, what would you do?
Miscellaneous

Is your property fenced?
No
Yes
If yes, please provide type of fence and height:
How do you plan to groom the animal?
Pay for Grooming
Groom the pet myself
If you plan to pay for grooming, how much are you willing to pay per month for this?
What will you do with your pet when you travel?
If your pet becomes ill, what will you do?
How do you plan to exercise your pet?
What happens to the pet if you discover a bad habit we have not identified (i.e. chewing, digging, etc.)?
Are you willing to continue training your pet (i.e. obedience, housetraining, etc.)?
No
Yes
Personal References:

NamePhoneE-mailAddress
Professional References:


Landlord
(required if renting)
 Name
 Phone
 Address

Veterinarian
(required if currently have pets)
 Name
 Phone
 Address
Verification:

I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED HEREIN IS TRUE AND THAT I HAVE ANSWERED ALL QUESTIONS HONESTLY. I FUTHER CERTIFY THAT I AM AT LEAST 21 YEARS OF AGE. I UNDERSTAND THAT PROVIDING FALSE INFORMATION WILL RESULT IN THE APPLICATION BEING DENIED. I UNDERSTAND THAT HSTGC RESERVES THE RIGHT TO DENY ANY APPLICATION FOR ANY REASON FOR THE SAKE OF PROTECTING THE WELFARE OF THE ANIMAL. I UNDERSTAND THAT THIS APPLICATION IS SUBJECT TO THE APPROVAL OF THE HSTGC RESCUE AND ADOPTON COMMITTEE. I FURTHER UNDERSTAND THAT I WILL BE NOTIFIED OF AN APPROVAL OR DENIAL WITHIN 7 DAYS OF THE COMPLETION OF THIS APPLICATION. IF MY APPLICATION IS DENIED I UNDERSTAND THAT HSTGC MAY OR MAY NOT DISCLOSE THE REASON(S) THE APPLICATION WAS DENIED.

I UNDERSTAND THAT I HAVE ONLY SUBMITTED AN APPLICATION TO ADOPT AND THIS IS NOT AN ADOPTION CONTRACT AND THAT APPROVAL IS NOT GUARANTEED.

IT IS MY INTENTION TO INTEGRATE THE ANIMAL I AM APPLYING TO ADOPT INTO MY HOME AND LIFE AS A PET, COMPANION AND MEMBER OF MY FAMILY. I UNDERSTAND THAT THE ADOPTION OF ANY PET IS A COMMITMENT TO PROVIDE LOVE, SHELTER AND CARE TO HIM/HER FOR THE DURATION OF HIS/HER LIFE. I CERTIFY HERE THAT I AM READY TO MAKE THIS COMMITMENT WITH THE FULL KNOWLEDGE THAT MY PET MAY LIVE TO EXCEED 15 YEARS OF AGE. I AM PREPARED TO BE FINANCIALLY RESPONSIBLE FOR VETERINARY CARE INCLUDING BUT NOT LIMITED TO ANNUAL CHECK UPS AND VACCINATIONS. I AM PREPARED TO PROVIDE GROOMING, EXERCISE AND SOCIAL INTERACTION FOR THE PET.

I HEREBY AUTHORIZE HSTGC TO CONTACT MY REFERENCES AS PART OF THE SCREENING PROCESS FOR ADOPTION.

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