Adoption Form

ABOUT
- HAPPY TAILS
HELP
ADOPT
SURRENDER
CONTACT

ABOUT
- HAPPY TAILS
HELP
ADOPT
SURRENDER
CONTACT

Name of pet you are interested in adopting:
Are you looking for a companion for a current pet?

Yes No
Full Name *
First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

How long have you lived at your current address?
Do you currently:
If you rent - Name of complex & landlord/manager's phone number:
If you rent, are pets allowed in your building?

Yes No
Home Phone:
Cell Phone:
Email Address: *
Alternate contact name (Parent, sibling, etc.) & phone number:
Number of adults in your household: *
Number of children & ages:
Occupation & Employer: *
If you are not employed, please explain how you will pay for the care of your new pet:
Are you currently a student?

Yes No
If you answered yes to the previous question, are you full or part time? Please include the name of your school.
Please list spouse or roommates names and phone numbers.
Who is this pet for?

Yourself Spouse Child Someone else
The new pet will stay indoors what % of the time? *
The new pet will stay outside what % of the time? *
Please clarify:
Do you anticipate the new pet being left alone for extended periods of time each day? *

Yes No
Where will it be kept while alone? *
Do you have a fenced yard? *

Yes No
Type of fencing:
Name of veterinarian, clinic name and phone number: *
Are all of your pets current on vaccinations?

Yes No
Have you turned in any pets to the shelter in the past 5 years? *

Yes No
How many?
Why?
Have you had any pets pass away in the past 5 years? *

Yes No
How many?
Why or how?
If you do not have any pets, have you ever cared for one in the past?

Yes No
Please explain:
Please list all the dogs, cats or other pets currently cared for in your household. Include age, male/female, whether spayed/neutered and if on heartworm preventative medication.
References (List 3 personal or professional references. Only 1 family member may be listed.)
Reference #1
Reference Name: *
Relationship:
Email Address: *
Phone Number: *
Reference #2
Reference Name: *
Relationship:
Email Address: *
Phone Number: *
Reference #3
Reference Name: *
Relationship:
Email Address: *
Phone Number: *
General Questions
Have you considered what you would do with your pet if you need to move? Please explain.
Your pet may live 15+ years. What would you do with your pet if you could no longer care for it?
Is anyone in your home allergic to pets?

Yes No
Do you feel financially secure to provide your pet with basic medical care and necessary medical care in case of an emergency? *
Are you aware heartworm disease is common in dogs?

Yes No
I have concerns/would like more information on the following regarding this pet:

Size Temperament Obedience Energy Level Housebreaking Other
How will you keep your dog confined to your property? (Check all that apply) *

In House On Chain Kennel Fenced Yard In garage Patio Other
I believe this pet will cost about (Select one) per month to keep.
I have the ability to pay for veterinary fees of emergency care for this animal of:
If I cannot afford the pet's veterinary care, I will:
Additional questions or information requested:
I verify the above information is true and correct. I understand that if any information provided by me is false or inaccurate, I will not be eligible to adopt from this organization now, or at any time in the future.
Your Name: *
Should be Empty:

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