Online Application Step 1 of 7 - Adoption Type 0% Adoption TypeAnimal Type*SelectDogCatRabbitBirdSmall MammalName of dog that you wish to adopt: Personal InformationName* First Last Home Phone*Work PhoneCell PhoneEmail* Occupation Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Are you less than 18 years old? Yes We perform home visit for every animal that is adopted. Do we have your permission to visit your home using the address you provided above?* Yes No Previous Adoption ApplicationsHave you applied for an animal previously through the HSFC?* Yes No What was the date of that application?* What was the outcome of that application?* Pet HistoryList the animals you have owned previously. Provide two examples below.First Example:What type of animal was it?* Name* Age*(Numbers only, no letters, e.g. 12)Sex* Female Male Was it spayed or neutered?* Yes No Where was it housed?* Do you still own the animal?* Yes No What happened with the animal?* Second Example:What type of animal was it?* Name* Age*(Numbers only, no letters, e.g. 12)Sex* Female Male Was it spayed or neutered?* Yes No Where was it housed?* Do you still own the animal?* Yes No What happened with the animal?*List any additional animals you have owned in the last five years:Please list the Veterinary Practice who see your Pets: Please list the Veterinarian Name who see your Pets: Vet's Phone NumberPLEASE UNDERSTAND THAT YOU SHOULD CALL YOUR VET TO INFORM HE/SHE THAT AN HSFC VOLUNTEER WILL BE CALLING TO VERIFY RECORDS REGARDING THEIR TREATMENT OF YOUR PETDo we have your permission to call your vet?* Yes No Home InformationWhy do you want to adopt an animal?*Do you own or rent your home?* Own Rent Where do you live?*Home TypeHouseApartmentDuplexCondoTownhouseWith ParentsWhat is the name of your condo/apartment complex?* What is the Manager's Name?* What is the Manager's phone number?*YOU SHOULD INFORM YOUR APARTMENT MGR THAT AN HSFC VOLUNTEER WILL BE CALLING TO DETERMINE IF THEIR ARE ANY BREED OR SIZE RESTRICTIONS AT YOUR FACILITY!Do we have your permission to call your manager?* Yes No Please detail any restrictions on pets such as weight, type or number of pets.How many adults live in your home?*List other persons at this address not adopting this animal:How many children live in your home?*What are their ages? Lifestyle InformationIs someone at home during the day?* Is someone at home at night?* Do you think that dogs should live outside?* Yes No Do you think that pets should go outside?* Yes No Why?*Will this dog be going outside for more than recreation?* Yes No Will this animal be going outside?* Yes No Please elaborate*Who will have responsibility for feeding?* Exercise Responsibility?* What is Your Viewpoint on Declawing?*Grooming Responsibility?* Training Responsibility?* Who will have responsibility for the pets expenses?* How were you referred to our Humane Society?*This animal may require a spay/neuter surgery, rabies vaccine or other medical expenses following adoption. Are you prepared to take on these expenses?* Yes No Because it is very stressful for an animal to go from home to home, we hope to place each one in a caring home for the rest of its life, which could be up to 20 years. Are you prepared to make this commitment?* Yes No Because it is very stressful for an animal to go from home to home, we hope to place each one in a caring home for the rest of its life, which could be up to 10 years. Are you prepared to make this commitment?* Yes No Because it is very stressful for an animal to go from home to home, we hope to place each one in a caring home for the rest of its life. Are you prepared to make this commitment?* Yes No What will happen to the animal if you have to move?*In an effort to ensure the animal's lifelong well-being, we screen our adopters very carefully and sign a legal contract with them. If at some point, you can no longer care for the animal we require that you return it to us. This way, the animal may be re-adopted to other qualified applicants and once again be protected by a legal contract. How do you feel about this?*This animal may take several weeks or months to fully adjust to you, your home and your animals. How would you ease the adjustment?*How will you exercise the dog?*What behavior to you regard as unacceptable?*How would you handle these behaviors?*How would you correct or discipline this animal?*Do you believe in spaying or neutering? Why?* Closing InformationAre your current pets properly licensed? Yes No Have they been vaccinated? Yes No If accepted, when would you like to take your pet home?* Check the subjects you would like to learn more about: House Training Feeding Household Dangers Heartworm Prevention Intro To Home Behavioral Problems Obedience Grooming Check the subjects you would like to learn more about: Litter Training Feeding Scratching/Declawing Upper Respiratory Infections Grooming/Fleas Household Dangers Feline Leukemia Feline Aids Urinary Problems Introducing New Pets Check the subjects you would like to learn more about: Litter Training Feeding Grooming/Fleas Household Dangers Introducing New Pets Check the subjects you would like to learn more about: Training Feeding Grooming Household Dangers Introducing New Pets Check the types of dog you are interested in: Adult Dog Companion For Other Pet Puppy Affectionate Dog Two Dogs/Puppies Children's Pet Short Hair Particular Breed Check the types of cat you are interested in: Adult Companion For Other Pet Kitten Affectionate Lap Cat Children's Pet Two Compatible Cats/Kittens Particular Breed Inside Cat Outside Cat Declawed Cat Check the types of rabbit you are interested in: Adult Young Companion For Other Pet Two Compatible Rabbits Short Hair Long Hair Particular Breed Children's Pet Check the types of small mammal you are interested in: Adult Young Companion For Other Pet Two Compatible Small Mammals Short Hair Long Hair Particular Breed Children's Pet Check the types of bird you are interested in: Adult Young Companion For Other Pet Two Compatible Birds Particular Breed Children's Pet I understand HSFC is looking for the best possible home for this companion animal. I further understand HSFC can and will use its sole discretion to determine the best qualified candidate for this animal. I understand that you will be contacting my veterinarian for the vaccination and health history of the pets I currently own or have owned in the past. I release, through my signature on the application, my veterinarian to provide that information to you. I am aware that prior to placement of a pet from the HSFC, my currently owned pets, for their protection, must be up to date on needed vaccinations. I certify that all the information in this application is true, and I understand that false information may void this application. REVIEW AND MAKE CORRECTIONS PRINT THIS PAGE FOR YOUR RECORD AS CHGS CANNOT BE MADE ONCE SUBMITTED!NameThis field is for validation purposes and should be left unchanged. Δ