Homeward Animal Shelter : Adopt or Foster : Dog Adoption Application

The Homeward Animal Shelter strives to place the animals entrusted to our care in permanent, loving homes. The purpose of this application is to aid us in that process and to get acquainted with prospective adopters. We want to help you in your choice of a dog that will be well suited to your family, home, and lifestyle. Your decision is important since this is a lifetime commitment.

Your Contact Information

First Name (Required)

Last Name (Required)

Street Address (Required)

Apt/Suite #

City (Required)

State / Province (Required)

Postal / Zip Code (Required)

Home/Cell Phone # (Required)

Work Phone

Co-Applicant's First Name

Co-Applicant's Last Name

Co-Applicant's Phone #

Are you at least 18 years of age?

Dog Information

Name of Dog(s) you are interested in adopting:

Name of dog(s) you are interested in adopting (Required)

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Have you ever owned a dog?

Are you aware of the time, financial cost, and commitment involved in owning this dog?

Have you discussed the energy level of this dog with a staff member?

Who are you adopting this pet for?

Who are you adopting this pet for? (Required)

Why do you want to adopt a dog?

Guard Dog
Companionship
Outdoor Dog
Indoor Dog
Breeding
Watch Dog
Service/Therapy
Gift for Someone

If Gift for Someone, Who?

If you move in the future, what will you do with the dog you adopt?

If you move in the future, what will you do with the dog you adopt? (Required)

During the day, where will this dog be kept? (Check all that apply)

Indoors
Outdoors
Crate
Garage
Kennel
Other

If Other, please specify

During the night, where will this dog be kept? (Check all that apply)

Indoors (House/Apt)
Indoors (Garage/Other)
Outdoors
Crate
Garage
Kennel
Other

If Other, please specify

This pet will be without human companionship for how many hours per day and how many days per week?

Hours per day (Required)

Days per week (Required)

Do you plan to take your dog to obedience training?

If yes, where will you go to obedience training at?

If no, please explain how you will handle any behavioral problems that may occur?

About You & Your Household

Please indicate the type of you home live in?

House - Own
House - Rent
Mobile Home - Own
Mobile Home - Rent
Apartment - Rent
Condo - Rent
Live with Parents

If live with parents, list parent's name(s)

Parent's phone number

If you rent, Landlords/Rental Agencies will be contacted to verify permission to own pets. This includes mobile home parks. Please provide the following:

Name of apartment complex or mobile home park

Landlord's or Rental Agency's Name

Landlord's or Rental Ageny's Phone Number

Do you have a fenced yard?

If Yes, type/height

How many people live in your household? (Required)

If there are any children under the age of 18 in the household, please list their ages here:

Ages of children in home:

Do you run a daycare in your home?

If yes, please list the ages of the children in your care.

Are you a student?

If yes, please indicate whether you are a full-time or part-time student. Also explain what you will do with this animal when the acedemic year is over.

Are all household members in agreement with this adoption?

If No, please explain who is not in favor and why.

Do any household members have pet-related allergies, and if so, to what?

If yes, explain

Current & Previous Pets

Have you ever adopted a pet from this or any other shelter/rescue?

If yes, please indicate whether you still have this pet. If you no longer have this pet, please explain why.

Have you ever given a pet away or surrendered a pet to a shelter/rescue organization?

If Yes, please explain the circumstances.

Please list all animals in your care in the last 5 years (include roommate's or relative's pets currently residing in your home).

Please list the following for each pet: Name of Animal; Species (dog,cat,other); Breed; Age; Are they spayed/neutered? Still living with you? If not, please explain why.

Name of Veterinary Clinic used for your pets

Veterinary Clinic Phone Number

Whose name(s) are the pet(s) records under at the vet?

Personal References

Please list two references who:

a) Know you well
b) Do NOT live with you
c) Did NOT accompany you to the shelter.

At least one reference must be unrelated to you.

Reference #1 First Name (Required)

Reference #1 Last Name (Required)

Reference #1 Relationship (friend, neighbor, co-worker,etc.) (Required)

Reference #1 Phone Number (Required)

Reference #2 First Name (Required)

Reference #2 Last Name (Required)

Reference #2 Relationship (friend, neighbor, co-worker,etc.) (Required)

Reference #2 Phone Number (Required)

Adoption Discounts

Please mark if any apply to you. We offer discounted adoption fees for senior citizens (ages 65 and over), as well as active military members and veterans. We may ask for proof of age/service.

Senior Citizen (65 yrs. and older)
Active Military Member or Veteran
N/A

Since many animals come from unknown backgrounds, Homeward Animal Shelter cannot be responsible for the health or behavioral problems and cannot guarantee personality or temperament. Therefore, I am prepared to provide any necessary medical care including regular vet care and annual vaccinations as well as any humane behavioral training required.

Check this box to indicate that you understand and agree to the above.

By typing my name below, I certify that the information I have given is true and that I recognize that any misrepresentation of the facts may result in my losing privilege of adopting a pet. I authorize investigation of all statements on this application.

(Required)