Adoption Application

Full Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

E-mail *

Birth Date *

Month Day Year

Residence *

House, own House, rent Apartment or Condo Military on base housing Military off base housing Live with parents Dorm or other on-campus housing

Time in Hawaii? *

Time in Service? (Military only)

How long have you lived at above residence? *

How long to you plan to stay at this residence? *

Landlord's Name *

Landlord's Number *

If you do move in the future, what are your plans for your animals? *

Personal reference and contact information: *

What is your occupation? *

Work hours: *

Who is your employer? *

Employer's contact information? *

Secondary caregiver's occupation? *

Secondary caregiver's work hours: *

Secondary caregiver's employer *

Secondary caregiver's Employer contact information *

List ALL people living in your home. (include yourself) *

	Name	Age	Gender	Relation
1.
2.
3.
4.
5.

Is anyone in your home sensitive to dander? *

Yes No

Name of your veterinarian: *

Phone number of your veterinarian: *

- Area Code Phone Number

Tell us about the animals you have had in the past, that you no longer own: (If none, enter N/A) *

	Name	Breed	Length of Ownership	Died/Rehomed/Lost	Notes:
1.
2.
3.
4.
5.

Have you ever given a pet away before, to anyone, for any reason? If so, please tell us about that experience. *

Please tell us about your CURRENT animals: ( If none, enter N/A) *

	Name	Breed	Male or Female?	Fixed?	Age	Temperament	Time with you	Notes:
1.
2.
3.
4.
5.
6.

Name of specific animal? *

Breed / Age of specific animal? *

Why would you like to adopt this animal? *

Where would the animal be housed? (Inside, outside, kennel, yard, etc) *

Do you have experience with this type of animal? *

This animal needs to get along with: *

Dogs Cats Kids under 5 Kids over 5 Just me Men Women Other animals not listed

I prefer our future dog to have a activity level that is: *

Low Medium High No Preference

What type of personality are you hoping for in your new pet? *

What concerns, if any, do you have about adopting a new animal? *

Are there any behaviors this animal could have that would be totally unacceptable to you? *

If your existing cats or dogs are not spayed or neutered, please tell us why:

* I have read the above information carefully and have filled out this application honestly. I understand that omission of information and/or failure to answer all questions and sign the application can result in this application being declined. Also, if an omission or untruth is discovered after an adoption takes place, I understand that the rescue reserves the right to annul the adoption and reclaim the animal. I give the rescue permission to contact veterinarians and related officials. I understand the adoption decision is dependent on many factors, including but not limited to the compatibility of the family and home to the individual pet, and other applications received on this pet. I understand it is the rescue sole prerogative to decide which home is most appropriate, that my application can be denied at any time for any reason, that their decision is final and I will not contest it. It is our goal to place animals in loving, lifelong homes and any information gathered is used only to that interest. *

Yes No

Adoption Application

Basic and Housing Information

Occupation and Family

The animal you are interested in: