Houston Pets Alive! · Adoption Application

Animal Information

Animal Type

*

Animal Name

*

Animal ID

Animal Gender

Breed

Description

How did you hear about this cat/dog?

*

Would you like to add another animal's information?

Yes

No

Animal #2-Type

*

Cat

Dog

Animal #2-Name

*

Animal #2-ID

Animal #2-Gender

Female

Male

Animal #2-Breed

Animal #2-Description

Animal #2-How did you hear about this cat/dog?

Adoption Applicant Information

Name

*

First Name

Last Name

Driver License Number

*

Date of Birth

*

(mm/dd/yyyy)

Address

*

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Email

*

Verify Email

*

Home Phone

Cell Phone

*

Employer

Employer Phone

List other members of your household - name, age, and relationship to you

*

One per line

Are all members in your household in agreement to adopt a pet?

*

Yes

No

Have you been convicted of a crime other than a misdemeanor?

*

Yes

No

If yes, please explain

*

Other Pets

Currently, do you have any pets in the home?

*

Yes

No

Pet #1-Name, Age, Breed

Pet #2-Name, Age, Breed

Pet #3-Name, Age, Breed

Pet #4-Name, Age, Breed

Are all pets in the home spayed or neutered?

*

Yes

No

I do not have any other pets

Are all pets in the home up to date on vaccines?

*

Yes

No

I do not have any other pets

Veterinarian Name

*

Veterinarian Phone

*

Why do you want a pet?

*

Home Information

Where do you reside?

*

Home

Apartment

Condo

Townhome

Mobile Home

If renting, Landlord's Name

Landlord's Phone

Do you object to a HPA! representative visiting your home?

*

Yes

No

Do you have a fenced yard?

*

Yes

No

Where will your pet stay during the day?

*

If your pet is to stay outside during the day, please explain where he/she will stay and what food, water and shelter will be provided

*

How many total hours will your pet be alone throughout the day?

*

Where will your pet stay during the night?

*

Will you provide monthly flea control for your pet?

*

Yes

No

Will you provide monthly heartworm preventative for your pet?

*

Yes

No

If you are unable to keep your pet for any reason, what will you do?

*

References

Please provide the name and phone number for two people that Houston Pets Alive! can contact to verify your information and ability to care for a pet.

Reference #1-Name

*

First Name

Last Name

Reference #1-Phone

*

How do you know this person and for how long?

*

Reference #2-Name

*

First Name

Last Name

Reference #2-Phone

*

How do you know this person and for how long?

*

By submitting this application you are also subscribing to the HPA! emailing list, from which you may opt out at any time.