"Home At Last” Adoption Application

Not every pet will fit your lifestyle. Our adoption counselors will ask you many questions to determine which pet will do well in your home and which will not. This way we can be sure the pet you get will be the pet you will love for a lifetime!

Full Name *

Full Name
Over 18 years old? *

Over 18 years old? Yes No

Are you over 18 years old
Full Address Full Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Full Address
Daytime Phone Daytime Phone * - ### - ### ####

Daytime Phone
Evening Phone Evening Phone - ### - ### ####

Evening Phone
Email

Your Email Address
How long at this address, if less than three years please give your previous address too *

How long at this address, if less than three years please give your previous address too
Do you own or rent your home, if you rent a statement from the landlord, with address, and phone number is required *

Do you own or rent your home, if you rent a statement from the landlord, with address, and phone number is required Own Rent

Do you own or rent your home, if you rent a statement from the landlord, with address, and phone number is required
Your Occupation & Place of employment *

Your Occupation & Place of employment
Employer’s name and phone number *

Employer’s name and phone number
Would you consent to a pre-adoption and post-adoption home visit *

Would you consent to a pre-adoption and post-adoption home visit
What pets have you owned before *

What pets have you owned before
What animals do you own now *

What animals do you own now
Are they spayed or neutered? *

Are they spayed or neutered
Do your pets tolerate other animals *

Do your pets tolerate other animals
Name & phone # of your veterinarian *

Name & phone # of your veterinarian
Name & phone # of a personal reference

Name & phone # of a personal reference
Are there Children in the family? If so, how many & what are their ages? *

Are there Children in the family? If so, how many & what are their ages?
Are you financially prepared to provide the necessary care for your pet including: proper food, vaccinations, parasite control (fleas, ticks, worms, etc.), licensing, adequate shelter, and veterinary care for yearly check-ups, or an after-hours medical emergency or illness, which could cost $500 or more? *

Are you financially prepared to provide the necessary care for your pet including: proper food, vaccinations, parasite control (fleas, ticks, worms, etc.), licensing, adequate shelter, and veterinary care for yearly check-ups, or an after-hours medical emergency or illness, which could cost $500 or more?
Where will your pet spend most of the daytime? Night time? *

Where will your pet spend most of the daytime? Night time?
Are you willing to commit yourself and your energies to this pet for its lifetime *

Are you willing to commit yourself and your energies to this pet for its lifetime
What do you consider a good reason to give up your pet *

What do you consider a good reason to give up your pet
I am interested in the following type, breed, age, size, and color of animal (or name of pet) *

I am interested in the following type, breed, age, size, and color of animal (or name of pet)
About how many daytime hours a day, will you be able to be at home with your pet *

About how many daytime hours a day, will you be able to be at home with your pet
I affirm that all information above is true. I realize that this is a lifetime commitment and will endeavor to give this pet a happy & healthy home. IF THERE ARE PROBLEMS WITH THIS PET, I WILL IMMEDIATELY CONTACT MY ADOPTION COUNSELOR/FOSTER PARENT FOR ASSISTANCE, OR IF I MUST GIVE IT UP, I WILL RETURN IT TO THE FOSTER HOME. I WILL HOLD THE ADOPTION COUNSELOR/FOSTER PARENT HARMLESS FOR ANY PHYSICAL, PSYCHOLOGICAL, MEDICAL, PERSONAL PROPERTY, OR OTHER DAMAGE AND INJURY *

I affirm that all information above is true. I realize that this is a lifetime commitment and will endeavor to give this pet a happy & healthy home. IF THERE ARE PROBLEMS WITH THIS PET, I WILL IMMEDIATELY CONTACT MY ADOPTION COUNSELOR/FOSTER PARENT FOR ASSISTANCE, OR IF I MUST GIVE IT UP, I WILL RETURN IT TO THE FOSTER HOME. I WILL HOLD THE ADOPTION COUNSELOR/FOSTER PARENT HARMLESS FOR ANY PHYSICAL, PSYCHOLOGICAL, MEDICAL, PERSONAL PROPERTY, OR OTHER DAMAGE AND INJURY Agree Disagree

I affirm that all information above is true. I realize that this is a lifetime commitment and will endeavor to give this pet a happy & healthy home. IF THERE ARE PROBLEMS WITH THIS PET, I WILL IMMEDIATELY CONTACT MY ADOPTION COUNSELOR/FOSTER PARENT FOR ASSISTANCE, OR IF I MUST GIVE IT UP, I WILL RETURN IT TO THE FOSTER HOME. I WILL HOLD THE ADOPTION COUNSELOR/FOSTER PARENT HARMLESS FOR ANY PHYSICAL, PSYCHOLOGICAL, MEDICAL, PERSONAL PROPERTY, OR OTHER DAMAGE AND INJURY
Signature (your name typed here is a legal and binding signature) *

Signature (your name typed here is a legal and binding signature)
Date *

Date
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