hsomc.org | Adoption Application

Animal ID#

The animal I'm applying for is a:*

Dog
Cat
Other

Primary Caregiver's Name*

FirstLast

Email

Address*

Street AddressCityStateZip Code

Primary Phone*

Secondary Phone

Housing*

Own Home
Apartment/Rent
Other

If you rent, provide your landlord's name and phone number:

We will require permission from the property owner that you are allowed to have a pet.

How long at current residence?*

Including you, how many members are in your family and/or household?*

If you have children, or children reside in your household, please list each of their ages (separated by commas):

Do you currently have pets at home?*

Yes
No

Current Pet #1: I have a...

Dog
Cat
Other

Is this pet spayed/neutered?

Yes
No

How long have you owned this pet?

Current Pet #2: I also have a....

Dog
Cat
Other

Is this pet spayed/neutered?

Yes
No

How long have you owned this pet?

Current Pet #3: I also have a...

Dog
Cat
Other

Is this pet spayed/neutered?

Yes
No

How long have you owned this pet?

List any other pets you might have:

Veterinarian Information

A call to your veterinarian will be placed by a HSOMC representative for a reference check in order to verify that your past and present pets have been kept up to date on preventative health care, including sterilization. This is a requirement. A home visit may be required before the adoption process can be finalized. It is important that any other pets you have are given a chance to interact with the potential new pet in order to see if they will be compatible. If any issues need to be addressed prior to finalizing the adoption process, we will discuss those options that may help minimize stress.

Vet’s Name and/or place of Business:

Vet's Address

Street AddressCityStateZip Code

Vet's Phone

If you currently do not have any pets at home, but have owned one in the past, tell us about it here:

On average, how many hours per day will the dog be left alone?

Where will the dog be kept during the day or within the hours that nobody is home?

Would you consider taking your new dog to obedience training?

Yes
No

The animal I'm applying for will be kept primarily:*

Indoors
Outdoors
Both

Who will be responsible to care for your new pet on a daily basis?*

Have you previously adopted a companion from a shelter or rescue group?

Yes
No

What was the name of the organization?

References

If you have never owned a pet, include names and phone numbers of 3 personal references, only one of which may be a relative.

Reference #1 Name

FirstLast

Reference #1 Phone

Reference #2 Name

FirstLast

Reference #2 Phone

Reference #3 Name

FirstLast

Reference #3 Phone

In the News

A Letter from the President: August 2010

Adoption Story: Tucker

Have You Recently Adopted? Share Your Story!

Adoption Application

HSoMC Adoption Form

Veterinarian Information

References

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