Holly's Place Adoption Application - Holly's Place Animal Rescue

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?

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?

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:

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):

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Holly’s Place Adoption Application

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