Adoption Application

How did you hear about the shelter or the animal you'd like to adopt?*

I am interested in adopting a:*

Name of the cat or dog you'd like to adopt.*

TELL US ABOUT YOURSELF

Name*

First Last

Address*

HSHC will not adopt outside of the United States.

Street Address Address Line 2 City State ZIP Code

Email*

Driver's License Number*

Date of Birth*

Home Phone*

Work Phone

Cell/Other Phone*

Emergency Contact*

First Last

Emergency Contact Phone*

Are you at least 18 years of age?*

Yes
No

Are you at least 21 years of age?*

Yes
No

Have you ever surrendered a personal pet to this or any other shelter/rescue group?*

Yes
No

If yes, please explain

Please tell us what type of pet you are looking for:*

Indoor Pet
Outdoor Pet
Indoor/Outdoor Pet

Is any member of your household allergic to animals?*

Yes
No

If yes, they are allergic to:

Cats
Dogs
Both

Please tell us why you are wanting to adopt a pet (choose all that apply)*

Companionship for me/myself
Companionship for my current pet(s)
Protection
Watch Dog
Breeding
Mouser
He/She will be a gift

TELL US ABOUT YOUR HOUSEHOLD

Tell us about your current housing situation*

Landlord's Name:*

First Last

Landlord's Phone Number:*

TELL US ABOUT YOUR FAMILY

Please tell us about your current household*

Live Alone
Adults Only
Family with children

Are there children/grandchildren who visit your home?

Yes
No

How often do they visit?

List all members of the household and their ages.*

The activity level in your home is*

Quiet
Active
Very Active

Do all members of your household know you are planning on adopting a pet?*

Yes
No

How will you confine a pet to your property?*

Fenced Yard
Garage
Basement
Crate
Loose within residence
Outdoor Kennel

If you have a fenced in yard, what kind is it?*

Invisible
4 ft Chain Link
6 ft Privacy
Other

Where will this pet be kept during the day?*

Where will this pet be kept at night?*

What will you do with this pet when you travel/go out of town?*

Boarding Facility/Vet's Office
Family or Friends Watch Them
Leave Home Alone
Take With You

What will you do with this pet if you have to move from your current dwelling?*

Take With You
Re-home to Family or Friends
Return to Shelter
Leave

If adopting a dog, are there any other dogs (other than your own) that this dog must get along with? (Relative's dog, neighbors, etc.)*

Yes
No

What training methods would you use to handle potential problems with your new pet (barking and/or meowing, crate training issues, chewing/scratching, housebreaking, going outside the litter box, etc.)?*

TELL US ABOUT YOUR PETS

Do you currently have any pets?*

Yes
No

How many pets do you currently have (total)?*

If yes, please check all that apply:*

Cats
Dogs
Other

How many years have you owned these pets?*

What are their ages?*

Are they male or female?*

Are they spayed/neutered?*

Are they kept indoors, outdoors, or both?*

Are they current on vaccines?*

Name of your Veterinarian

Veterinarian's Phone

Please tell us about your PAST pets (adult life only - past 10 years).

Previous Pet #1

Cat or Dog?

Cat
Dog

Male or Female?

Male
Female

How long did you own them?

What happened to him or her?

What was their age?*

Previous Pet #2

Cat or Dog?

Cat
Dog

Male or Female?

Male
Female

How long did you own them?

What happened to him or her?

What was their age?*

Previous Pet #3

Cat or Dog?

Cat
Dog

Male or Female?

Male
Female

How long did you own them?

What happened to him or her?

What was their age?*

Ready to Adopt?

Apply to Adopt an Animal

TELL US ABOUT YOURSELF

TELL US ABOUT YOUR HOUSEHOLD

TELL US ABOUT YOUR FAMILY

TELL US ABOUT YOUR PETS

Please tell us about your PAST pets (adult life only - past 10 years).

Previous Pet #1

Previous Pet #2

Previous Pet #3