Homeward Bound Pet Rescue po box 4335 Irmo, sc 29063 803-454-9094 Application To Adopt a pet



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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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