Happy Whiskers Animal Assistance, Inc.

Name * First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Email
Home Phone * ### - ### - ####
Work Phone ### - ### - ####
Cell Phone ### - ### - ####
Name of Spouse/Partner/Roommate First Last
First Last
First Last
Length of time at current address
Place of employment
Ages of any children in household
Is anyone in your home allergic to animals?
Yes No
If yes, please explain:
What type of home do you live in?
If rented are pets allowed?
Yes No
Name of current landlord
Landlord phone number ### - ### - ####
Name of Pet(s) your interested in adopting
Why are you interested in adopting a pet?
Do you currently have pets at home?
Yes No
Please list pets you currently own:
Please list all previous pets and explain why you no longer have them:
Name of current Veterinarian
Veterinarian phone number: ### - ### - ####
Where will the Cat/Dog live?
Day
Night
Is there anyone home during the day?
Yes No
If no, how long will the pet be left alone during the day?
Dog Adopters Only
If your are adopting a dog, will you be using a crate?
Yes No
Explain:
Do you have a fenced yard?
Yes No
If yes, what material is the fence made of?
How tall is the fence?
If no, are you willing to install a fence?
Yes No
All Adopters
Are you prepared to deal with health issues ifthe dog/cat needs special care later in life?
Yes No
What do you consider to be the limitations to providing health care for the older dog/cat?
Do you intend to be a multiple dog/cat household?
Yes No
What characteristics to you want your dog/cat to have?
Is there any other information you would like us to know?
Do Not Fill This Out

Happy Whiskers Animal Assistance, Inc.

Where will the Cat/Dog live?

Dog Adopters Only

All Adopters