Harvest Hills Animal Shelter Adoption Application

* Indicates required fields.

YesNo

YesNo

YesNo

YesNo

YesNo

YesNo

YesNo

YesNo


YesNo



YesNo



YesNo


OwnRentLive with familyLive with other


YesNo


Please tell us about the veterinarian whom you would visit with your pet.


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


CurrentPast


MaleFemale
YesNo
YesNo

YesNo

Pet 2


CurrentPast


MaleFemale
YesNo
YesNo

YesNo

Pet 3


CurrentPast


MaleFemale
YesNo
YesNo

YesNo

Pet 4


CurrentPast


MaleFemale
YesNo
YesNo

YesNo

Pet 5


CurrentPast


MaleFemale
YesNo
YesNo

YesNo

Pet 6


CurrentPast


MaleFemale
YesNo
YesNo

YesNo

Pet 7


CurrentPast


MaleFemale
YesNo
YesNo


CatDog

Dog questions

First time ownerHave had 1 or 2Experienced

YesNo

YesNo


YesNo

DogsFree Roaming CatsChickensLivestock (goats, cows, horses, etc)

YesNo

What do you plan on doing with your pets during and after your move?

CompanionChildrenGuardHuntingGift

Cat questions

First time ownerHave had 1 or 2Experienced

YesNo

YesNo

YesNo

What do you plan on doing with your pets during and after your move?

CompanionChildrenMouserGiftBarn cat


Please provide two non-family personal references.

Reference 1


Reference 2


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.

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