Adoption Application Holly’s Place Adoption Application The following information is requested so that we can make the best placements possible for both the companion animal and you. Please answer all questions that are applicable to your situation. In order to be considered as an adopter you must: be 21 years of age Have identification showing your present address. Have the knowledge and consent of your landlord. Be willing to spend the time and money necessary to provide training, medical treatment and proper care for the animal. Adoption Application Name of Animal you are interested in Adopting: * Date * Name of Applicant * Phone * Email Address * Street Address * City, State & Zip * Describe the qualities in the dog or cat you are looking for: Will this be your first companion animal? Yes No What kinds of companion animals have you had? Which do you still have? Have they been spayed or neutered? Yes No What happened to the ones you no longer have? Will your present animals adjust to a new one in the house? Yes No N/A Why do you want this dog or cat? Companion Companion for other animal Watch dog Guard dog Personal protection House dog OtherOther What brand of food do you currently feed to your companion animals, or what did you feed to previous animals? Do your current dogs receive heartworm preventative? What kind of flea preventative do you use on your dogs and/or cats? Animals can be expensive to care for (estimated average animal cost is at least $750.00 for one dog.) Are you willing and able to provide adequate food, shelter and medical care, including yearly checkups and vaccinations, for an adopted animal? How many adults are there in your household? How many children? Ages? Does any household member have an allergy to dogs or cats? Yes No How many hours will the animal be alone during the day? Where will he/she be kept while alone? Do you live in: House Apartment Mobile Home OtherOther Do you: Own Rent your home? If you rent, may we contact the owner to obtain permission for this cat to live in your home? Yes No Owner's Name and Phone NumberOwner's Name and Phone Number Where do your current (or did your past) companion animals live? Indoor only Outdoor only Indoor/Outdoor Where will the new cat or dog live? Indoor only Outdoor only Indoor/Outdoor What are your feelings about cats and dogs getting on furniture? Have any of your past or current cats been declawed? Yes No What methods would you use to alter undesireable behavior in this cat or dog (such as scratching furniture, rough play, getting on counter tops, chewing etc)? Your veterinarian's Name & Phone Number Veterinarian's City or Town Do you have a completely fenced yard? Yes No Fence height: What kind of fence? Is the fence attached to the house so no one can enter the fenced area directly from the house? Yes No If you drive a pickup truck, would you allow the dog to ride in the back? Yes No If you go away for a few days, or on a vacation, who will take care of the dog or cat? If you must move, will you take the dog or cat with you? Yes No What problems would make you return an animal? Barking Housebreaking Chewing Jumping Up Shyness/other fears Shedding Digging Scratching or climbing on furniture Other or NoneOther or None To help resolve problems, are you willing to use a crate? Yes No Take an obedience class? Yes No Under what other possible circumstances would you return the animal: Move New baby Divorce High cost of animal's care Personal illness OtherOther Are you willing to have a representative of Holly's Place come to see where your dog or cat will be living? Yes No Are you willing to take responsibility for this animal for the next 10-15 years? (Please think about this question full prior to answering.) Yes No Have you ever applied to adopt a dog or cat from Holly's Place in the past? Yes No Under what circumstances do you think euthanasia is appropriate? Please list a non-family personal reference (with phone number) The information above is true and correct (sign and date): Submit If you are human, leave this field blank.