Animal You're Interested in Adopting
Applicant's Name
*
First Name
Last Name
Applicant's Job/Employer
*
Spouse's Name
*If applicable
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone Number
*
(###)
###
####
Email
Type of Property
*
House
Townhouse
Apartment
Condo
Mobile Home
Other
If you rent, name of landlord/complex
Number of Adults in Household
*
Ages of Children in Household
Please List the Name, Breed, Gender, and Age of all Animals You Have Owned in the Past Five (5) Years.
If the animal is deceased, please write "DECEASED" after the age they passed away.
EXAMPLE:
Zeus, Boxer, Male, 5
Hera, Poodle, Female, 8 DECEASED
Loki, Cat, Male, 1
Were All of the Above Listed Animals Spayed or Neutered?
If You Answered "No," to the Previous Question, which animal(s) were NOT Spayed or Neutered?
Are All of the Above Listed Animals Kept in the House?
If You Answered "No" to the Previous Question, Which Animals Were NOT Kept in the House? Where were they kept?
Describe Your Ideal Pet.
*
Why Do You Want to Adopt?
*
What Kind of Pet Are You Looking For?
*
How Much Time Are You Prepared to Allow for Your New Pet to Adjust to Your Home?
*
Under What Circumstances Would You Return This Pet?
*
Have You Ever Turned an Animal in to a Shelter?
*
Yes
No
If Yes, Why?
How Will You Entertain/Exercise Your Dog?
Dogs only, applicants interested in cats please ignore.
Do You Have a Fenced In Yard?
Dogs only, applicants interested in cats please ignore.
Where Will the Dog Be When You Are Home?
Dogs only, applicants interested in cats please ignore.
Where Will the Dog Be When You Are Not Home?
Dogs only, applicants interested in cats please ignore.
Where Will the Dog Be When You Are Asleep?
Dogs only, applicants interested in cats please ignore.
How Will You House Train Your Dog?
Dogs only, cat applicants please ignore.
What Would You Do If You Moved to a Residence Where Pets Were Not Permitted?
*
Why Do You Want to Adopt This Animal? What Makes You The Best Home We Can Find For This Animal?
*
By checking the below box, I certify that the above information is complete and accurate and that I am at least 18 years of age. I realize that any misrepresentation of fact may result in my losing the privilege of adopting an animal. I understand that Homeward Bound Waggin, Inc has the right to deny my request for adoption. I authorize verification of all statements on this application, including but not limited to prior vet medical history. I understand that this application is the property of Homeward Bound Waggin, Inc who reserves the right to share this information with other shelters and rescue organizations.
