Adoption Application

Name of Applicant*

Date*

Address*

Street Address City State ZIP Code

Home Phone*

Work Phone

Email*

Pet's Information

Pet's Name*

Adoption Fee

Microchip # (if applicable)

Species*

Dog
Cat

Pet Details

Male
Female
Altered
Unaltered

Pet Breed

Pet Color

Pet DOB

Please choose your form of payment:*

Cash
Check
Paypal
Credit Card

Please provide three references. If possible, please use your personal veterinarian as one reference.

Reference 1 Name*

Reference 1 Phone*

Reference 2 Name*

Reference 2 Phone*

Reference 3 Name*

Reference 3 Phone*

How long have you resided at your current address?*

If less than two years, what was your previous address?

Does anyone in your household have allergies?*

Yes
No

Does anyone in your household have Asthma?*

Yes
No

Do you currently have any children in your home or that visit frequently?*

Yes
No

If so, what are their ages?*

Do you:*

Rent
Own

Type of residence*

Apartment
House
Mobile Home
Condo

Landlord's name and phone:*

Have you asked permission of your landlord to have this pet at your residence?*

Yes
No

What will happen to your adopted pet if you would have to move?*

Employment Status

Are you currently employed?*

Yes
No

Employer’s Name:

Employer’s Address:

Employer’s Phone:

How long have you been employed there?

If unemployed, how do you plan to financially care for your pet?

Other Information

Why is this pet the best choice for you?*

Have you had previous experience with this particular breed?*

Yes
No

Do you have a completely fenced in yard?*

Yes
No

If you don't have a fenced in yard, how will you exercise your pet?*

If you have a fenced in yard, please describe:*

How many hours do you work in an average day?

Where will your pet be kept during this time?*

Where will your pet sleep during the night?*

Do you currently have any pets in your home?

Yes
No

If yes, please describe your pets:*

Have you previously owned any pets?*

Yes
No

If yes, what happened to them?*

Are your current pets up to date on their vaccinations?*

Yes
No

Have you ever had to give up an animal?*

Yes
No

If yes, please explain:*

Adoption Affidavit:

*

I agree to provide my adopted pet with shelter, food, water, exercise & attention that he/she requires.

*

I understand and agree that a home visit will be mandatory prior to finalizing this adoption.

*

I agree that any and all expenses incurred after this custodial exchange is solely my responsibility and Hopeless to Homes Animal Rescue is released of any and all liabilities and financial obligations.

*

I agree that my adoptive pet is to never be used for breeding, fighting, training to fight, or experimental use of any kind.

*

I understand and agree that in the event my adopted pet should need medical attention, I will take him/her to a licensed veterinarian in a timely manner and follow the advice of that veterinarian. I will purchase any and all recommended medications and give as directed.

*

I understand and agree that I am required to take my adopted pet in to a licensed veterinarian for routine vaccinations and checkup as stated by city ordinance laws.

*

I agree to never “de-bark” my adopted dog. I understand and agree that this is their means of defense against potential threats. I also understand if I partake in this procedure, my adoption will become null and void and my pet will be confiscated.

*

I agree to allow Hopeless to Homes Animal Rescue come to my home to check on my adopted pet.

*

I understand and agree that if Hopeless to Homes Animal Rescue has any concerns on the wellbeing of my adoptive pet or feel my adoptive pet is in danger or being neglected, they reserve the right to confiscate him/her.

*

I understand and agree that if my adoptive pet is confiscated and medical attention is required; I am solely responsible for any and all financial aspects to bring that animal back to an acceptable standard of health.

*

I understand that my adoptive pet may not be altered at the time of adoption and I agree to protect him/her from engaging in any and all reproductive acts.

*

I understand that my adoptive pet will need to be altered if he/she is not already and agree to discuss the procedure and costs with Hopeless to Homes Animal Rescue on or before my adoption date.

*

I understand that if my adopted pet is relinquished or confiscated from my home, I will be unable to adopt from Hopeless to Homes Animal Rescue in the future.

*

I understand that all adoption fees/surrender fees along with donations are solely used to care for the animals within the rescue and that Hopeless to Homes Animal Rescue does not profit from these monies.

*

I understand that any information shared by Hopeless to Homes Animal Rescue is of their own experience and therefore no guarantees can be made in regards to behavior.

*

I understand that rescue animals often times are victims of abuse and neglect and may react to certain situations in a questionable manner.

*

I understand that I am welcome to contact Hopeless to Homes Animal Rescue at any time if advice or help is needed with my adoptive pet.

*

I agree that if I am no longer able to care for my adoptive pet; I will call Lacey Boxley at (605) 222- 3251 or email hopelesstohomes@gmail.com and return my adoptive pet safely to Hopeless to Homes Animal Rescue so that another home can be found.

*

I agree to never sell, trade, or surrender this pet to any agency or persons aside from Hopeless to Homes Animal Rescue.

*

I understand and agree that my adoption fee is a non-refundable donation and there is no reimbursement of this adoption fee if the adoption does not work out.

Any Additional Comments:

By submitting this application, I affirm that the facts set forth are true and complete. I understand that if I am approved as an adopter, any false statements, omission, or other misrepresentations made by me on the application may result in immediate dismissal.

Electronic Signature*

Enter your full name