TELL US ABOUT YOURSELF
Name*
First Last
Address*
Please note, we are located in Noblesville, Indiana, USA.

Street Address Address Line 2 City State ZIP Code
Email*
Driver's License Number*
Date of Birth*
Date Format: MM slash DD slash YYYY
Cell/Other Phone*
Home Phone
Work Phone
Emergency Contact*
Please, list someone other than yourself.
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
Please, explain.*
Please tell us what type of pet you are looking for:*
- Indoor Pet
- Outdoor Pet
- Indoor/Outdoor Pet
What would that look like in your household?*
Is any member of your household allergic to animals?*
- Yes
- No
Who in the home is allergic?*
What are they are allergic to?*
- Cats
- Dogs
- Both
Please tell us why you are wanting to adopt a pet.*
Select all that apply.
- Companionship for me/myself
- Companionship for my current pet(s)
- Protection
- Watch Dog
- Breeding
- Mouser
- He/She will be a gift
Please, explain.*

TELL US ABOUT YOUR HOUSEHOLD
Tell us about your current housing situation*
- Own my own home/condo
- Renting an apartment/condo/house
- Living with parents/relatives
Apartment Complex Name*
Landlord's Name:*
First Last
Landlord's Phone Number:*
Homeowner's Name:*
First Last
Homeowner's Phone Number:*
Does your parent/relative rent or own their home?*
- Rent
- Own

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
Please, list ages of each child that visits and how often they visit.*
Child's Name Age Visits per Month Relationship to Applicant
Please, list the names and ages of all persons living in your home including yourself.*
Person Age
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?*
Check all that apply.
- Fenced Yard
- Garage
- Basement
- Crate
- Loose within residence
- Outdoor Kennel
Please, explain.*
If you have a fenced in yard, what kind is it?*
- Invisible
- 4 ft Chain Link
- 6 ft Privacy
Where will this pet be kept during the day?*
- Crate
- Restricted to 1 Room in Home
- Loose in Home
- Outdoor Kennel
- Tie-out in Yard
- Loose in Fenced Yard
Please, explain.*
Where will this pet be kept at night?*
- Crate
- Restricted to 1 Room in Home
- Loose in Home
- Outdoor Kennel
- Tie-out in Yard
- Loose in Fenced Yard
Please, explain.*
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?*
E.g. relative's dog, neighbor's dog, significant other's dog, etc.
- Yes
- No
- Interested in Adopting a Cat
Please, explain.*
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 THE PETS CURRENTLY LIVING IN YOUR HOME
Do you currently have any pets?*
- Yes
- No
How many pets do you currently have in total?*
Name of your Veterinarian*
Veterinarian's Phone*
Are all of your pets current on vaccines?*
- Yes
- No
Pet #1
Species*
- Cat
- Dog
Gender*
- Male
- Female
How many years have you owned them?*
If owned for less than a year, enter "0".
How old is your pet?*
If less than a year old, enter "0".
Pet #2
Species*
- Cat
- Dog
Gender*
- Male
- Female
How many years have you owned them?*
If owned for less than a year, enter "0".
How old is your pet?*
If less than a year old, enter "0".
Pet #3
Species*
- Cat
- Dog
Gender*
- Male
- Female
How many years have you owned them?*
If owned for less than a year, enter "0".
How old is your pet?*
If less than a year old, enter "0".
Pet #4
Species*
- Cat
- Dog
Gender*
- Male
- Female
How many years have you owned them?*
If owned for less than a year, enter "0".
How old is your pet?*
If less than a year old, enter "0".
Pet #5
Species*
- Cat
- Dog
Gender*
- Male
- Female
How many years have you owned them?*
If owned for less than a year, enter "0".
How old is your pet?*
If less than a year old, enter "0".
Pet #6
Species*
- Cat
- Dog
Gender*
- Male
- Female
How many years have you owned them?*
If owned for less than a year, enter "0".
How old is your pet?*
If less than a year old, enter "0".
Pet #7
Species*
- Cat
- Dog
Gender*
- Male
- Female
How many years have you owned them?*
If owned for less than a year, enter "0".
How old is your pet?*
If less than a year old, enter "0".
Pet #8
Species*
- Cat
- Dog
Gender*
- Male
- Female
How many years have you owned them?*
If owned for less than a year, enter "0".
How old is your pet?*
If less than a year old, enter "0".
Pet #9
Species*
- Cat
- Dog
Gender*
- Male
- Female
How many years have you owned them?*
If owned for less than a year, enter "0".
How old is your pet?*
If less than a year old, enter "0".
Pet #10
Species*
- Cat
- Dog
Gender*
- Male
- Female
How many years have you owned them?*
If owned for less than a year, enter "0".
How old is your pet?*
If less than a year old, enter "0".
ADDITIONAL ANIMALS
Do any pets frequently visit your home?*
- Yes
- No
Please, tell us about your pet visitors.*
Name Species Visits per Month
No Pets in Home*
No Pets
I certify that I do not have any pets living in my home or visiting my home.

ENewsletter
We would like to keep you in the loop on current adoptable pets, events and more.
I'd like to receive emails from HSHC.

Adoption Application

Step 1 of 7

TELL US ABOUT YOURSELF

TELL US ABOUT YOUR HOUSEHOLD

TELL US ABOUT YOUR FAMILY

TELL US THE PETS CURRENTLY LIVING IN YOUR HOME

Pet #1

Pet #2

Pet #3

Pet #4

Pet #5

Pet #6

Pet #7

Pet #8

Pet #9

Pet #10

ADDITIONAL ANIMALS

TELL US ABOUT YOUR PAST PETS

Previous Pet #1

Previous Pet #2

Previous Pet #3

Previous Pet #4

Previous Pet #5

Previous Pet #6

Previous Pet #7

Previous Pet #8

Previous Pet #9

Previous Pet #10

Child's Name	Age	Visits per Month	Relationship to Applicant

Person	Age

Name	Species	Visits per Month