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 Country

Home Phone

Cell Phone(Required)

Place of Employment(Required)

Work Phone

Is 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)

Do You Own or Rent Your Home(Required)

Landlord'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 Name

Dog/Cat

Breed

Age

Sex

Spayed/Neutered?

Click 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)

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