Harvest Hills Animal Shelter Adoption Application * Indicates required fields. I am interested in Are you aware that dogs need to be licensed yearly and there is a leash law?* YesNo Are you aware that cats and dogs are required by state law to be vaccinated against rabies yearly or every 3 years after initial vaccination?* YesNo Most shelter animals have unknown medical backgrounds. Are you prepared to pay for any medical treatments this pet may require?* YesNo Animals are not created perfect. Are you willing to make every attempt to correct any behavioral problems that may occur with this pet?* YesNo Are you willing to give this pet all the love, care an attention it deserves?* YesNo Do you understand that adoption fees are non-refundable, and that Harvest Hills cannot guarantee the health of any animal?* YesNo Do you agree to keep your pet up-to-date with vaccinations?* YesNo Do you give us permission to contact your veterinarian?* YesNo Have you ever surrendered an animal to a shelter before?* YesNo Why did you surrender the animal? Name* Physical Address* My mailing address is the same.* YesNo Mailing Address Home telephone Mobile telephone Email* Place of Employment Work telephone Are you 21 years of age or older?* YesNo What is your current age? What is your housing arrangement?* OwnRentLive with familyLive with other Landlord's name Landlord's telephone How many people in your home?* Children's ages Do all of the adults know that you are planning to adopt?* YesNo Please tell us about the veterinarian whom you would visit with your pet. Veterinarian's name Veterinarian's telephone Do you have any pets at this time or have you had pets during the past two years?* YesNo Please provide information about your current pets and those you have owned in the past two years. All pets must be current on rabies vaccinations. We highly recommend distemper vaccines as well. Pet 1 Name Status CurrentPast Breed Age Sex MaleFemale Spayed or neutered YesNo Vaccines up-to-date? YesNo More pets? YesNo Pet 2 Name Status CurrentPast Breed Age Sex MaleFemale Spayed or neutered YesNo Vaccines up-to-date? YesNo More pets? YesNo Pet 3 Name Status CurrentPast Breed Age Sex MaleFemale Spayed or neutered YesNo Vaccines up-to-date? YesNo More pets? YesNo Pet 4 Name Status CurrentPast Breed Age Sex MaleFemale Spayed or neutered YesNo Vaccines up-to-date? YesNo More pets? YesNo Pet 5 Name Status CurrentPast Breed Age Sex MaleFemale Spayed or neutered YesNo Vaccines up-to-date? YesNo More pets? YesNo Pet 6 Name Status CurrentPast Breed Age Sex MaleFemale Spayed or neutered YesNo Vaccines up-to-date? YesNo More pets? YesNo Pet 7 Name Status CurrentPast Breed Age Sex MaleFemale Spayed or neutered YesNo Vaccines up-to-date? YesNo Select one or both - I would like to adopt a CatDog Dog questions Dog experience First time ownerHave had 1 or 2Experienced Do you understand and accept that a change in a dog's environment may cause accidents, especially in the first few days of adoption?YesNo For how many hours will the dog be left alone during the day? Where will the dog be kept during the time alone? Where will the dog sleep at night? Do you have a fenced yard? YesNo How will you confine the dog to your property? Are you willing to build a fence if the dog you are interested in needs one? YesNo Animals owned by your neighbors DogsFree Roaming CatsChickensLivestock (goats, cows, horses, etc) Who will watch your pets while you are away? Are you planning on moving in the next year? YesNo What do you plan on doing with your pets during and after your move? Why are you adopting a dog? CompanionChildrenGuardHuntingGift Cat questions Cat experience First time ownerHave had 1 or 2Experienced Do you understand and accept that a change in a cat's environment may cause accidents, especially in the first few days of adoption?YesNo Will your cat be allowed outside? YesNo Who will watch your pets while you are away? Are you planning on moving in the next year? YesNo What do you plan on doing with your pets during and after your move? Why are you adopting a cat? CompanionChildrenMouserGiftBarn cat Please provide two non-family personal references. Reference 1 Name* Telephone* Reference 2 Name* Telephone* Please read and digitally sign below by placing your name in the signature box in the following style: /john smith/ I, the undersigned, have read and truthfully answered the above questions. I understand that Harvest Hills has the right to refuse or deny any application, especially if it is in the best interest of an animal. I realize that any false information could result in forfeiture of the animal. I understand that adoption fees are non-refundable, and that Harvest Hills cannot guarantee the health of any animal. I have read and agree with the statement above.* Signature* Date*