Name of Animal You Wish To Adopt (if known) or description of animal you are looking to adopt:

Your Name: 
Address:
City:   State:   Zip:
Home Phone:   Work Phone:
Place of Employment:
Working Hours:
E-Mail Address:
Are You 21 or Older? 

HOUSEHOLD INFORMATION:

1.  Do you live in a:
          House
          Apartment 
          Condo 
          Mobile Home
          Live with relatives

2.  Do you:  Rent   Own  Live at Home
3.  Approximately square footage of home:
4.  If you rent:  Are pets allowed?
     Landlord's name:
     Does your landlord require a deposit? 
5.  Do you have a fenced-in yard? 
     How big an area is fenced?
     How tall is the fence?
     What type of fence (chainlink, privacy, barbed wire, etc.)?
6.  Number of adults in home:   Number of people home during day:
7.  Number of children in home:   Ages of children:

PET INFORMATION:

1.  Number of pets currently in household:
     If you have other pets, are they spayed/neutered?
     Are your other pets current on their vaccinations?
     Are your other dogs on Heartworm preventatives?
2.  Have you had other pets in the last five years?
     What happened to them?
3.  Have you ever adopted an animal from us before? If so, when?
4.  Where do your present pets spend the majority of the time when you are home? 

5.  Where do your present pets spend the majority of the time when you are NOT at home?

6.  Where do your present pets sleep?
7.  Where will this pet spend the majority of its time?
8.  Where will this pet sleep?
9.  If adopting a cat, are you planning to declaw the cat?
10.  If adopting a dog, have you ever housetrained a dog before?
11.  Why do you wish to adopt this animal?
          Watchdog  
          Companion Animal
          Hunting Dog
          Breeding
          As a gift for someone:  Inside your household  Outside your household

12.  Where will this pet spend most of its time when you are at home?
13. Where will this pet spend most of its time when you are NOT at home?

VETERINARIAN INFORMATION:

1.  Name of current veterinarian: 
2.  Name & city of veterinarian clinic: 
3.  Standard medical care costs from $100 - $200 per year.  Emergency care can cost hundreds of dollars.  Are you willing to provide standard and emergency care for this pet? 

POST-ADOPTION REQUIREMENTS:

1.  You must take the animal to a veterinarian within seven (7) days of the adoption for a check-up (if HHLP has not had the animal examined).
2.  You are required to sterilize this pet if it has not already been sterilized.  Your adoption fee covers the sterilization but you are responsible for seeing that it is performed.
3.  You must return the animal to us if you decide you can no longer keep it.  You cannot transfer ownership or sell the animal or give it away to someone else without the consent of Helping Hands for Little Paws.
4.  You are responsible for providing proper shelter, food, water, exercise, medical care, and humane treatment at all times for this animal.

Helping Hands for Little Paws tries to ensure that all animals we adopt are healthy.  If you take an animal home and it becomes sick, we will gladly take the animal back.  However, we will not be responsible for any veterinary bills incurred in the interim.  Do you agree to this provision? 

I certify that the information given on this Adoption Application is true and correct.  I am not less than twenty-one (21) years of age.  I have read, understood, and have received a copy of the conditions of the Adoption Agreement.  If I am approved by Helping Hands for Little Paws to adopt an animal, I agree to all the conditions of the Adoption Agreement.

Signature of Adopter:          Date: 
Typing your name in this box is considered to be your signature!