Pet Adoption Application
City of Hernando Animal Shelter
Name of the pet you're interested in adopting
*
Your Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How long at this address?:
*
Are you planning on moving within the next 6 months?
*
Yes
No
If yes, what are your plans for your pets if you move?
Home Phone Number
-
Area Code
Phone Number
Cell Phone Number
-
Area Code
Phone Number
Name of Employer:
*
Work Phone Number
-
Area Code
Phone Number
Up until what time of night can we contact you via phone?
*
E-mail
*
Birth Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
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31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
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1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Do you own your own home?
*
Yes
No
If no, name and phone # of landlord:
Type of Dwelling:
*
Please Select
House
Apartment
Condo
Mobile Home
Name and age of ALL occupants in household (including yourself):
*
If no children, do you plan on having children or will children be visiting the household frequently?
*
Yes
No
What is your reason for wanting to adopt a pet?
*
Companion
Companion for pet
Mouser - catch mice
Gift
Guard Dog
Other
If other, please explain:
How many total hours in a day will your new pet be left alone?
*
How many total hours in a day will your new pet be left alone outdoors?
*
Where would your new pet be kept when alone?
Do you have a fenced yard?
*
Yes
No
If yes, which type of fence?
*
Wood
Chain Link
Split Rail
N/A
If yes, how tall is your fence?:
*
Do you have locks and/or latches on all your gates?
*
Yes
No
N/A
If you have dogs, are they ever put on tie outs?
*
Yes
No
Not sure
Are any members of your household allergic to animals?
*
Yes
No
If yes, please describe:
Who will have chief responsibility for the care of your new pet?
*
Over the past 5 years, how many pets have you owned? (Include current pets)
*
Please Select
0
1
2
3
4
5
6+
List each individually including breed, age, still living with you? (if not, why?)
If yes, when?
Have you ever lost or given away a pet?
*
Yes
No
If you currently own pets, how do they react to new animals?
Are your present pets up-to-date on their annual vaccines?
*
Yes
No
N/A
If no, please explain:
Are your present pets spayed or neutered?
*
Yes
No
N/A
If no, please explain.
Were your previous pets spayed or neutered?
*
Yes
No
N/A
If no, please explain.
How much are you financially prepared to spend for routine/emergency medical care, licensing, etc?
*
What plans do you have for your new pet when you are on vacation?
*
Age of pet you would consider adopting: (check all that apply)
*
Kitten/Puppy
Young
Adult
Special Needs
Senior
Bonded Pair
Are you able & willing to provide your new pet with with monthly heart worm/flea/tick prevention?
*
Yes
No
Who is your current or most recent veterinarian? Please provide their NAME and PHONE NUMBER:
*
If your new pet displays behavioral problems (such as jumping on people, excessive barking, potty accidents, scratching furniture, not using the litter box, etc.) how would you go about correcting the behavior?
*
Contact a Professional
Call us for advice
Personal Knowledge
Other
If other, please explain:
What type of solution would you be willing to try if house training accidents continue after the first week (check all that apply)?
*
Try crate training
Use potty pads
Have pet examined by vet
Install a dog door
Call us for advice
Try new litter
Return the pet to us
Other
If other, please explain:
Is your entire immediate family in agreement with the decision to bring a new pet into your home?
*
Yes
No
If anyone is NOT, please explain:
Are you prepared to commit to a pet for 15 - 20 years (average life span)?
*
Yes
No
Have you or any member of your household ever been charged with cruelty to animals or negligence in animal care?
*
Yes
No
If yes, please describe:
Have you ever adopted or applied to adopt a pet from us before?
*
Yes
No
Name of pet previously applied for or adopted:
Pet’s Name
Cat or Dog?
Adoption/Application Date
Where will your pet spend most of his/her time?
*
Please Select
Indoors Only
Outdoors Only
Indoors and Outdoors
Barn Cat
Basement/Garage
Confined
If you selected outdoor, would your new pet be supervised?
Yes
No
Where will your pet eat?
*
Where will your pet sleep?
*
If you are applying to adopt a DOG or PUPPY what type of heartworm prevention do you plan to use?
Please provide 2 personal references (only 1 can be a relative) who can verify that you are able and willing to provide proper care for a new pet.
Reference #1
*
First and Last Name & Relationship to Self
Reference #1 Phone Number
*
-
Area Code
Phone Number
Reference #2
*
First and Last Name & Relationship to Self
Reference #2 Phone Number
*
-
Area Code
Phone Number
If you were to become too ill to care for this pet, what would happen to him or her?
*
My family would keep the pet
Pet would go to a shelter
Friend would keep the pet
I don't know
My spouse will keep the pet
Other
If there is anything else you think we should know, please note it here.
I acknowledge that a non-refundable adoption fee of $75 for dogs and puppies or $50 for cats and kittens is required when a City of Hernando pet is adopted.
YES
NO
Please remember, it may take approximately 2 to 3 business days for us to get back to you.
Thank you!
Submit Adoption Application
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