Pet Adoption Application

    Contact Information



    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:

    (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

    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?

    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:


    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:




    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.