Homeward Bound Pet Rescue
PO Box 4335 Irmo, SC 29063 803-454-9094
Application To Adopt A Pet
Adopting a pet is a serious, long-term commitment.
This information will help us find the right pet to join your family!
Name Spouse/ Partner Roommate Name:
Address City State Zip Code
Phone(H) (W) (C)
E-mail
Occupation Employer
Age: Under 21 21 – 30 31 – 40 41 – 50 51 – 60 61 – 70 71 – 80 Over 80
Please list three personal references and their relationship to you:
Name Relationship Phone
Name Relationship Phone
Name Relationship Phone
Your veterinarian:
Name Address City State Zip Code
May we call your veterinarian for a reference? Yes No Telephone Number
Please describe the kind of dog you are interested in adopting:
Age Sex Breed/mix Size
Why would you like to adopt a dog? Companion Gift To Breed For a Child
As Guard Dog Companion for Another Pet Other_______________________________________________
Will it be a working dog? Yes No Will it be a hunting dog? Yes No
I am comfortable training my dog to improve manners and reduce destructive behavior. Very Some Not at all
Please provide the following information about your pets (if any), your children (if any) and your home:
Your dogs:
Have you ever adopted from Homeward Bound? Yes No Type? Dog Cat Where is the pet now?
How many dogs do you have? Breed/mix Ages
How long have you had your current pet?
If none, have you owned any dogs in the last 10 years? Where are they currently?
Did you: buy From breeder? From a store? Adopted from a shelter? Inherited? Rescued Other
Are pets spayed/neutered? Yes No If no, why not?
Are pets on heartworm preventative? Yes No What type:
Your cats:
How many cats do you have? Ages Do they get along with dogs?
Your home:
Number of adults? Own Rent Number of children? Ages Have they ever been afraid of dogs?
Landlord’s name Telephone Number
If you rent, do you have written permission from your landlord to have a dog?
Do all adults in household know you wish to adopt?
Do you live in: apartment duplex townhouse single house mobile home other
Yard info: Fenced? Yes No Type? privacy-all sides chain link-all sides underground height?
Your New Dog:
Explain how will your dog spend its days? ______________________________________________________________________
______________________________________________________________________________________________________
Explain how will your dog spend its nights? __________________________________________________________________
______________________________________________________________________________________________________
What will happen to your dog when you have to travel or have an emergency away from your home?(Check everything that applies) Pet sitter Family member will look after Board at kennel Will take with me
Leave in yard Leave in house Other: _________________________________________________________
How many hours do you leave your pets alone each day? 2-4 4-6 6-8 8-10 10-12 12-14 14+
Under what circumstances might you consider giving up your pet? (Check everything that applies)
Moving Baby Not Getting Along with Other Pets Behavioral Problems Children Lost Interest
Too Time Consuming Allergies Separation/Divorce Medical Problems Other ____________________________
Are you willing to make a 10-15 year commitment for this animal? Yes No
Are you financially able to provide monthly heartworm prevention for your pet and will you commit to do so? Yes No
Home visit. I/we agree to allow you to visit my/our home by appointment as part of our application or your follow-up process. Yes No
Application Information. All of the information I/we provided in this application is true and correct. If any of the information changes, I/we will advise you promptly. Yes No
Date: Signature
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