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Adopt A Pet Adoption Application Animal(Required) Cat Dog Name of animal you are interested in Name(Required) First Last Email(Required) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Home PhoneCell Phone(Required)Place of Employment(Required) Work PhoneIs it OK to call at work?(Required) Yes No Are you 18 years of age or older?(Required) Yes No Consent(Required) I am accompanied by parent's/guardian witnessed by a HSWC staff member.Number of Adults in the Household(Required)Please enter a number less than or equal to 10.Ages of Children in the household(Required) Add RemoveDo You Own or Rent Your Home(Required)OwnRentLandlord's Name (if applicable)(Required) Landlord's Number (if applicable)(Required)Is a security deposit required?(Required) Yes No Is there an added monthly rental fee?(Required) Yes No Why do you want to adopt an animal?(Required)Will this animal reside at the above address?(Required) Yes No Will this cat live inside?(Required) Yes No Will this dog live inside?(Required) Yes No What would you do with the animal if you moved?(Required)How did you hear about us?(Required) Word of mouth Flyer Radio/TV Print Media Internet Website(Required) Please list all cats and dogs currently in the household(Required)Pet's NameDog/CatBreedAgeSexSpayed/Neutered? Add RemoveClick the plus (+) sign to add additional pets in your household.Is your pet(s) vaccinated against rabies?(Required) Yes No Is your pet(s) vaccinated against distemper?(Required) Yes No If cat(s) in the household, has your cat(s) been tested for feline leukemia (FeLV) and/or feline AIDS (FIV)?(Required) Yes No If dogs(s) in the household, do you give your dog(s) heartworm prevention medicine?(Required) Yes No If dogs(s) in the household, is your dog(s) licensed?(Required) Yes No For food/vet care, are you prepared to spend about $600/dog or $300/cat per year?(Required) Yes No What vet hospital(s) do you use (with phone numbers)? What name are the vet records under?(Required)Provide your email address if you wish to receive updates about shelter activities and information about animals and animal care.(Required) Consent(Required) I agree to these terms:I understand that falsification or omission of any of the above information will result in an automatic application denial. I authorize the release of my name and information for the exclusive use of Hills Science Diet so that I may receive promotional discounts, coupons, and other information from them. I give permission to my vet hospital to release any records pertaining to my animals or animals that I have owned to the HSWC for the purpose of processing my application. Date(Required) MM slash DD slash YYYY Home Page Share this:FacebookXLike this:Like Loading...