Adoption Application-HSA

This application has no guarantee of adoption. In order to adopt, you must visit our shelter.

Animal you are interested in adopting *
Are you 18 years old or older
Applicant's First Name *
Applicant's Last Name *
Street Address or PO Box *
City *
State *
Zip Code *
Email Address * Please enter correctly as this is the main way we will contact you
Confirm email
Cell Phone Number *
Date of Birth *
Drivers License Number *
Emergency Contact Name *
Emergency Contact Number *
How did you find out about us? *
Have you applied anywhere else for a pet? *
Where else have you applied for a pet? *
Is this pet for you or someone else? *
Do you own other pets at the current time? *
Please list their names, breeds, and ages. *
Are all of your pets spayed/neutered/fixed?
How many pets have you owned in the last 5-10 years? *
What happened to them? *
Are your pets current on their vaccinations? *
Have you ever turned your dog or cat into a shelter? *
If yes, please explain? *
Veterinarian's Name * If you have never owned a pet please tell us where you would go.
Veterinarian's Address, City, State, and Zip Code * Again if you have never owned a pet please list where you would go
Veterinarian's Phone Number *
Have you ever had a pet euthanized? *
If yes, please explain:
How do you feel about having pets spayed/neutered? *
Are you familiar with heartworm and heartworm prevention? *
If you have pets, will they adjust to a new pet in the house? *
Were any of your pets obedience trained? *
Please check the main reason you plan to adopt a pet: *
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? *
Please select your current residence type. *
If you answered "other" above, please explain here: *
How long have you lived at this address? *
If you rent, does your landlord and lease allow pets?
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? *
Does anyone in your household have allergies to dogs/cats? *
Employment Status *
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? *
What would you do if the bills went over this amount? *
Will this pet be predominantly living inside, outside, or 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? *
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? *
If yes, when will they be tied/chained up? *
Where will the animal sleep? *
If you answered "other" above, please explain:
Will the animal spend any time in the garage? *
If the animal will spend time in the garage, please explain when/why: *
Do you have a pool? *
Is there a fence around the pool? *
What kind of fence do you have around your pool? *
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? *
If no, please explain: *
Are you willing and able to exercise the dog on a regular basis? *
If yes, what is the method of exercise? *
If you answered "other" above, please explain: *
Have you ever been convicted of abuse or neglect of a child or animal? *
If yes, please explain: *
If you drive a pick up truck, would you allow the animal to ride in the back/bed? *
What arrangements will you make for the care of your pets in case of an emergency? *
If you answered "other" above, please explain: *
What will you do with the animal when you go on vacation? *
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? *
If you answered "other" above, please explain: *
Are you willing to take responsibility for this animal for the next 10-20 years? *
If no, please explain: *
Will you allow us to do a follow-up call? *
Please list two references(including phone number) *
By signing, I acknowledge that 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. *