Adoption Application
Animal you are interested in adopting
Bia (Dog - 23-258)
Bluster (Dog - 23-297)
Cleo (Cat - 23-343)
Cocoa (Dog - 23-336)
Colby (Dog - 23-301)
Daisy (Dog - 23-330)
Dolly (Dog - 23-332)
Fudge (Dog - 23-282)
Kinley (Dog - 23-315)
Kobe (Dog - 23-298)
Melon (Dog - 23-129)
Moe (Dog - 23-296)
Otis (Dog - 23-256)
Pixie (Dog - 23-333)
Rey (Dog - 23-233)
Rooster (Dog - 23-345)
Rose (Dog - 23-341)
Scooby (Dog - 23-302)
Sybil (Cat - 23-294)
Trinity (Dog - 23-303)
What is the name of your second choice?
Do you have specific qualities that a dog must possess to be successful in your home? Please check all qualities necessary below:
*
No
Yes
Good with other dogs
Good with cats
Good with kids
Housebroken
Crate Trained
Leash Trained
Active - Will go for walks/runs
Not Active - Does not need regular exercise
Applicant's First Name
*
Applicant's Last Name
*
Facebook Name
*
Street Address
City
*
State
*
Apartment Number (if applicable)
Zip Code
*
Phone Number
*
Email Address - Please verify that this has been typed in correctly. This will be the main form of communication.
*
Alternate Phone Number
Date of Birth- Must be 18
How did you find out about us?
Petfinder
Internet Search
Family/Friend
Staff/Volunteer
Facebook/Twitter
Other
Have you applied anywhere else for a pet?
No
Yes
If yes, where else have you applied for a pet?
Is this pet for you or someone else?
Myself
Someone else
Do you own other pets at the current time?
No
Yes
If yes, please list their names, breeds, and ages.
Are all of your pets spayed/neutered/fixed?
Yes
No
N/A
How many pets have you owned in the last 5-10 years?
0
1
2
3
4
5+
What happened to them?
Are your pets current on their vaccinations?
Yes
no
n/a
Have you ever turned your dog or cat into a shelter?
No
Yes
If yes, please explain?
Veterinarian's Name
Veterinarian's Address, City, State, and Zip Code
Veterinarian's Phone Number
Please contact your veterinarian and give consent to speak to our screening team. Failure to do so could disqualify you from adoption. Do you understand?
*
No
Yes
Have you ever had a pet euthanized?
No
Yes
If yes, please explain:
How do you feel about having pets spayed/neutered?
Agree
Disagree
Not Sure
Are you familiar with heartworm and heartworm prevention?
No
Yes
If you have pets, will they adjust to a new pet in the house?
Yes
No
Unsure
N/A
Were any of your pets obedience trained?
Yes
No
N/A
If the dog you adopted has behavioral issues what will you do?
Hire a trainer
Hire a behavioralist
Seek advice from friends and family
Return to rescue
Please check the main reason you plan to adopt a pet:
Companion
Family Pet
Child's Pet Guard Dog
Companion for another pet
Other
If you answered "other" above, please explain here:
Please describe in detail the pet you are looking for.
Do you own or rent your home?
Own
Rent
Someone else owns the Home
Someone else rents the Home
Please select your current residence type.
House
Apartment
Condo
Townhouse
Mobile Home
Other
If you answered "other" above, please explain here:
How long have you lived at this address?
Less than one month
1-2 months
3-6 months
6-9 months
9-12 months
1-2 years
3-5 years
6-10 years
10 + years
If you rent, does your landlord and lease allow pets?
Yes
No
Unsure
N/A
Landlord Phone Number- If you rent please include your landlord's phone number. If you do not include this information your application will not be processed.
Including yourself, how many people live in your household?
Please list the ages & relationship of those who live in your home.
Is everyone in your household aware that you are planning to adopt a pet?
Yes
No
N/A
Does anyone in your household have allergies to dogs/cats?
Yes
No
Possibly
N/A
Employment Status
Full-Time
Part-Time
Retired
Work from Home
Stay at Home Parent
Student
Unemployed
Other
If you chose "other" above, please explain:
If you are employed, what is your current occupation?
On average, how many hours per day will your pet be left alone?
How much do you think the annual medical bills will be for your pet?
About $100
$100 - $200
$200 - $300
$300 - $500
$500 +
What would you do if the bills went over this amount?
Will this pet be predominantly living inside, outside, or both?
Inside
Outside
Both
Please provide a description of this pet's living conditions.
Do you have a completely fenced-in yard? If so, what kind of fence?
Wood
Chain Link
Electric
Plastic
Iron
Other
Other (I do not have a fenced yard)
If you answered "other" above, please explain:
If you do not have a fenced yard, how will you let the animal out?
Are there times when the animal will be tied/chained up?
Yes
No
N/A
If yes, when will they be tied/chained up?
Where will the animal sleep?
In bed with me
In bed with my child
In a dog / cat bed
In a kennel / crate
Wherever he or she likes
Outside
Other
If you answered "other" above, please explain:
Will the animal spend any time in the garage?
Yes
No
N/A
If the animal will spend time in the garage, please explain when/why:
Do you have a pool?
No
Yes
Is there a fence around the pool?
N/A
Yes
No
What kind of fence do you have around your pool?
N/A
Wood
Chain Link
Plastic
Iron
Other
If you answered "other" above, please explain:
How will you handle housebreaking?
How will you handle destructive behavior?
Will you keep the animal up-to-date on vaccinations and heartworm preventative?
No
Yes
If no, please explain:
Are you willing and able to exercise the dog on a regular basis?
Yes
No
N/A
If yes, what is the method of exercise?
Walking
Running
Dog Park / Dog Run
Other
If you answered "other" above, please explain:
Have you ever been convicted of abuse or neglect of a child or animal?
No
Yes
If yes, please explain:
What arrangements will you make for the care of your pets in case of an emergency?
Leave with family/friend
Boarding
Pet Sitter
Take with me/us
Other
If you answered "other" above, please explain:
What will you do with the animal when you go on vacation?
Leave with family/friend
Boarding
Pet sitter
Take with me/us
Other
If you answered "other" above, please explain:
For what reason(s) would you consider returning/giving up the animal?
What would you do with your animal if you had to move?
Take him / her with me
Give to family or friend
Return to shelter
Other
If you answered "other" above, please explain:
Are you willing to take responsibility for this animal for the next 10-20 years?
No
Yes
If no, please explain:
Will you allow us to perform home checks?
No
Yes
Reference - Not related to you (name and phone)
*
Reference - Not related to you (name and phone)
*
Reference - Related to you (name and phone)
*
Reference Notified ( We will try to make contact 2 times and then process will be halted)
*
No
Yes
I have read the foregoing and certify that the answers I have given are complete, true and not misleading in any way. I am authorizing you to contact landlords, associations and veterinarians. You are also aware that we cannot guarantee the health and temperament of the animal.
I agree
I do not agree
Your application will be good for up to one year once approved. You only need to apply one time per year. If your application is not complete NHPR will not move forward in processing. Did you verify that your application is complete?
*
No
Yes
Do you understand that NHPR is not able to guarantee that you will be selected to adopt the animal that you have applied to adopt? We adopt on a first approved/best fit basis.
*
Yes, I understand
No, I do not understand