Hope Lives Here Adoption Application
Date
*
-
Month
-
Day
Year
Date Picker Icon
Application for (Name of Dog/Cat(s))
*
Applicant Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
Phone Number
*
-
Area Code
Phone Number
Are you 18 years of age or older ?
*
Yes
No
Preferred method of contact
*
Phone
E-mail
Are you
*
Employed - Full-Time
Employed - Part-Time
Full-Time Student
Part-Time Student
Unemployed
On average, how long are you away from home on a daily basis?
*
1 hour
2-5 hours
6-8 hours
8 hours +
Adoptive Home Information
Do you live in
*
Apartment
Condo
Duplex
House
Other
Please describe your home type
*
Do you own or rent your home?
*
Own
Rent
Please upload landlord approval for pets.
How long have you resided in your home?
*
How close is the nearest main road/highway to your home?
*
Do you have a fenced yard? (applicable for dog's only)
*
Yes
No
Please indicate fence height
Please describe your yard
If available, please include pictures of your yard
Adoptive Home Resident Information
Number of Adults (over 18 years old))
*
1
2
3
4
5
6
Number of Children (under 18 years old)
*
0
1
2
3
4
5
6
Are all residents in agreement regarding the adoption?
*
Yes
No
If no, please explain
Resident Pet Information
Have you had pets before?
*
Yes
No
If they no longer live with you, please provide details
Do you currently have pets?
*
Yes
No
Number of current resident pets
0
1
2
3
4
Resident Pet #1 Information
Pet Type
Dog
Cat
Small Animal (gerbil, hamster, rabbit)
Other
Age
Breed
Spayed/Neutered?
Yes
No
Resident Pet #2 Information
Pet Type
Dog
Cat
Small Animal (gerbil, hamster, rabbit)
Other
Age
Breed
Spayed/Neutered?
Yes
No
Resident Pet #3 Information
Pet Type
Dog
Cat
Small Animal (gerbil, hamster, rabbit)
Other
Age
Breed
Spayed/Neutered?
Yes
No
Resident Pet #4 Information
Pet Type
Dog
Cat
Small Animal (gerbil, hamster, rabbit)
Other
Age
Breed
Spayed/Neutered?
Yes
No
Current Veterinary Clinic
Address
Street Address
Street Address Line 2
City
State
Zip Code
Phone Number
-
Area Code
Phone Number
Current Veterinarian Name
First Name
Last Name
Adoptive Home Preferences and Suitability
What Age of dog/cat are you Looking for?
*
Puppy/Kitten (0- 2 years old)
Young (2-4 years old)
Adult (5-7 years old)
Senior (8 years +)
What activity level are you looking for in a new dog/cat?
*
Low
Medium
High
Where would the dog/cat be when you are home?
*
Where would the dog/cat be when you are at work?
*
While outside for a period of time would the dog be supervised? (Cat's not permitted outside)
*
Yes
No
Please describe how the dog woud be secure while outside (Cat's not permitted outside)
*
What would you do with your dog/cat if you were on vacation?
*
What would you do if you were unable to keep your dog/cat?
*
If you were forced to find a new residence what would you do with your pet(s)?
*
References
Reference #1 Name
*
First Name
Last Name
E-mail
Phone Number
*
-
Area Code
Phone Number
Relationship to you
*
Reference #2 Name
*
First Name
Last Name
E-mail
Phone Number
*
-
Area Code
Phone Number
Relationship to you
*
Reference #3 Name
*
First Name
Last Name
E-mail
Phone Number
*
-
Area Code
Phone Number
Relationship to you
*
Have you ever been charged or convicted with any criminal offence relating to animals or children?
*
Yes
No
Please describe details
Submit
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