First Name*
Last Name*
Address*
City*
State/Province*
Zip/Postal Code* -
Email*
Home Phone*
Work Phone x
Cell Phone*
Which animal are you interesting in?*
Do you own or rent your home* Choose one: Rent Own
If you rent, please enter your landlord's name and phone number:*
Employer:*
Who will be responsible for feeding, vet care costs, exercising and training?*
How much do you anticipate spending on your animal annually?*
If your pet developed a condition requiring treatment, what would you be willing to spend?*
Please list other pets currently in your household (ages, breed, gender, size, special needs):*
Are your current pets spay and/or neutered?
If your last pet(s) is deceased, what happened to it?*
Have you ever given up a pet? If yes, please explain:*
Date of current pet's last checkup:*
What heartworm preventative do you use?*
Veterinarian's name and phone number:*
Why are you interested in adopting a pet at this time?*
Who will have ownership of this dog/cat and what is the relationship to the applicant?*
How many people reside in your household? Their ages?*
Will the animal be kept inside or outside? Choose all that apply: Inside Only Outside Only Inside and Outside
Is your yard fenced?* Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced
What is the height of the fence?*
What type of fence is it?* Choose one: Privacy Chain Link Invisible
If looking to adopting a dog, will it receive daily walks?
If looking to adopt a dog, how will it receive exercise?*
If looking to adopt a dog, will it have a play area/section in the yard?*
Will your pet travel with you on trips?*
Where will the animal be kept when you are not home?*
If you have to leave your home in an emergency, such as hurricane, where will your pet stay?*
How will you care for the animal's coat and nails?*
Is seasonal shedding a problem for you or any family member?
If you move in the future, what will happen to your pets?*
How much time will the animal spend alone during the day?*
Where will the animal be kept when you are home?*
Where will the animal sleep?*
Are you familiar with the use of crates?* Choose one: Yes No
List at least one reference who is not a family member and contact information:*
HOPE for Animals, Inc. P.O. Box 1341 - Thibodaux, Louisiana 70302 non-profit 501 (c) 3 organization