Homeless Animal Lifeline (HAL) - Adoption Application

HOMELESS ANIMAL LIFELINE (HAL)
Adoption Application

Thank you for considering adoption! The following information is requested so that your adoption counselor can assist you in the selection of a lifetime companion. The animal’s welfare is our foremost consideration and we appreciate your cooperation in telling us more about you.

If you prefer to fill out a Word document and e-mail it as an attachment click here to download the form.

INSTRUCTIONS – PLEASE READ!
    - Complete all questions.
    - Press Submit to send your application
    - All inquiries related to the application should be emailed to: RescueHAL@aol.com

Animal's Name: Description: Date of Application:

ADOPTER

Your Name:

Home Street Address:

City: State: Zip:

Telephone: Home Cell:

Email:

Number of Children at Home: Ages:
Number of Adults in Home:

Is any member of the household (Choose one) Allergic to animals? Yes No Have asthma? Yes No

HOME

Describe your current living situation (Choose one):
Apartment Condo Duplex Single-family home I am in the process of moving

Do you rent or own your current residence (Choose one) Rent Own
Length of time living there:

This section to be completed by RENTERS ONLY
As a renter, you may be asked to supply a copy of your lease as a part of HAL’s adoption review.
Do you agree? (Choose One): Yes No

Are animals permitted by your landlord (Choose one): Yes No I don’t know
Landlord’s Name: Telephone:

If you move and a future rental does not allow pets, do you have a plan for the future care of the animal you are considering adopting from HAL? (Explain)

WORK

10.

Employer's Name: Work Phone:

11.

Does your work involve travel? (Choose one): Yes No
How will the animal be cared for during business and/or vacation travel? (Explain)

12.

How many hours per day would you estimate that the animal will be left alone?
During that time, where do you plan to keep the animal?

PETS

13.

Please list all of the animals (living/deceased) which you have had during the past 7-10 years
Type (Dog/Cat) Name Age Spay/Neuter (Yes/No) Living/Deceased

14.

Veterinarian's Name:
Address:
Telephone:

15.

Will your cat be (Choose one): Indoor Only Indoor/Outdoor

16.

Will you be declawing the cat you are adopting? (Choose one): Yes No
Have you ever declawed one of your own cat(s) in the past? (Choose one): Yes No

MISC

17.

Would you agree to a home visit by a representative of Homeless Animal Lifeline? (Check one): Yes No

18.

In the case of an emergency, illness or death of the primary care-giver, is there someone who will assume care and responsibility of the animal? (Explain):

19.

What will you do if your cat scratches furniture or displays other destructive behavior? (Explain):

20.

A cat’s lifespan can average 15-20 years. Are you financially prepared and willing to give this animal the recommended medical care it requires for its lifetime? (Check one): Yes No

21.

Is there any other information you would like us to know (Optional)

IN ORDER TO BE CONSIDERED BY HAL AS AN ADOPTER, YOU MUST:

Be at least 21 years of age
Have a picture ID showing your present address
Understand that we have the right to verify any information on this application, including a property check
Have the knowledge and consent of all adults living in your household
You must complete all of the above information

BY SIGNING BELOW, YOU CERTIFY THAT YOU UNDERSTAND:

HAL reserves the right to refuse adoption to anyone for any reason
HAL may choose not to reveal the specific reasons for adoption denial
The information above is accurate and not misleading in any way
The cats available for adoption originate from a variety of sources/situations. The temperament of an animal is not guaranteed. All animals are examined by a veterinarian upon entry into our program. Their health is routinely monitored while in our foster system, however, there can be a possibility that an animal is incubating an illness without showing any clinical signs.

Your Name: Date: