PET INFORMATION

Type of pet you want to adopt: Dog Puppy Cat Kitten Other If Other: If a particular pet, what is the name:

If no particular pet in mind, please describe the pet you are looking for (include sex preference, age range, breed, etc.):

  POTENTIAL ADOPTER'S CONTACT INFORMATION

Main Contact Name: Occupation:
Main Contact Phone: Other Phone:
Main Address: City: State: Zip Code:
Main Email Address:

Co-Applicant Name (if any): Occupation: Phone:
Co-Applicant Email Address:

  HOUSING INFORMATION

Housing Type: House    Apartment    Condo    Mobile Home  If checked House, do you Rent Own
How many years at residence?
If renting, do you have permission from Landlord/Complex Management to have a pet? Yes No  
Please provide Landlord/Complex name and phone: Phone:
We frequently do house checks of potential adopter's. Do you have any objections to this? Yes No     If Yes, explain why:

Please describe the new environment where the pet will be living if adopted. If you want to adopt a dog,
please include outdoor environment (fenced yard, kennel, urban, country setting, farm, etc.):

  OTHER OCCUPANTS

Children? Yes No   If Yes, what are the ages: Child 1:   Child 2:   Child 3:   Child 4:
If you have young children, please describe how you are going to prepare and introduce the new pet to them?

Are there any other relatives or roommates living in the same residence? Yes No
If Yes, who else?
If Yes, do ANY of them have any objections to a new pet? Yes No      If Yes, explain why (allergies, fear of, don't like, etc.)?

  PET OWNERSHIP HISTORY

Have you owned this type of pet before (not including childhood pets)? Yes No    How many pets do you currently own?
Please give a brief description of each pet that you currently own:

Have you owned pets that are now deceased? Yes No   If Yes, please give a brief description on what happened to them.

Veterinarian do you use/used:
Vet Location: Veterinarian Phone:
Pet names that were patients of this Vet (included deceased pets):

  NEW PET PLANS

This pet will be an Indoor Only Pet Outdoor Pet Only Both Indoor and Outdoor Pet This pet will be kept in the house. in a Kennel. in the basement. in the garage. in a dog house with tie. in the barn. Hours alone per day?
If cat, do you plan on declawing? Yes No Where do you plan on keeping litter box?
If dog, do you plan on a dog obedience course? Yes No      Describe any other plans or training you plan for your new pet.

  COMMENTS, ADDITIONAL INFORMATION OR QUESTIONS

I acknowledge by checking this box that the above information that is provided above is to
the best of my knowledge true and complete. I understand that HOMAR reserves the right
to disqualify me if any of the information is found false.

        

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