Pet Adoption Application Contact Information Applicant's name Which pet are you applying to adopt: Email address Phone number Address City State Zip Housing and Family Do you own or rent your place of residence? OwnRent If you rent, please provide your landlord's name and phone number: List landlord name and phone number here (by providing this information, you are allowing Hometown Rescue to contact your landlord. Please inform them of this call so they will speak to us) Would you object to a home visit? YesNo How many children live in your home? Have you or anyone in your household ever been charged with animal cruelty or neglect? YesNo Will the adopted pet be an indoor or outdoor pet? ---IndoorOutdoor How will you keep this pet confined to your property? Check as many as apply HouseKennelFenceChainPatioGarageLeashOther If Other is checked above, please list other methods of confinement: List other methods here Other Pets What type(s) of pets do you currently have in your home? DogCatBirdReptileSmall animals (e.g. hamster, gerbil)None If you have other pets, are they spayed/neutered? Yes, all of them.None at all.Some of them. Are your pets kept current on flea/tick and heartworm preventative? Yes, all of them.None at all.Some of them. Have you ever surrendered an animal to a shelter, police station or person? YesNo Have you ever returned an adopted or purchased animal? YesNo Veterinarian Do you have a regular veterinarian? YesNo If yes, please provide the name and phone number of your current veterinarian: List veterinarian name and phone number here Comments By submitting your application to Hometown Rescue, you certify that all of the information provided is true and complete. Any false information may result in nullifying this adoption. Hometown Rescue has the right to refuse adoption to anyone.