| HAMPSHIRE COUNTY PET ADOPTION PROGRAM |
HAMPSHIRE COUNTY PET ADOPTION PROGRAM (HCPAP) APPLICATION FOR ADOPTION
Please remember that adopting an animal is a SERIOUS commitment. Your new companion may take days,
weeks or even months to settle into their new environment. Your commitment will require tons of attention
and love. YOU are responsible for their health care cost. Sadly, too many animals are adopted and
returned simply because folks did not think through the adoption carefully enough. Our mission and
responsibility at HCPAP is to place the animals we rescue into an environment compatible with their needs
and to ensure their adoption is in the best interest of both the animal and the adopter. As such, please
initial this paragraph and answer the following questions.
Initials___________________
Date ____________________
( You MUST initial & date this application--- as well as FILL out EVERY question, if the question does not
pertain to you, then put N/A in the blank. Any question left blank will cause a delay in processing your
application or potentially cause the application to be denied. NO EXCEPTIONS! Thank you.)
NAME
STREET ADDRESS
CITY,STATE,ZIP
(You must provide at least 2 valid phone numbers)
HOME PHONE
CELL PHONE
WORK PHONE
EMAIL ADDRESS
AGE OF APPLICANT
If you have not resided at the given address for at least 2 years, please provide previous address.
STREET ADDRESS
CITY, STATE, ZIP
Can you present current identification with your current address listed?
ADDRESS LISTED:
EMPLOYER:
HOW LONG HAVE YOU WORKED THERE?
NUMBER OF PERSONS IN HOUSEHOLD ADULTS
TEENS
CHILDREN (over 2 years)
INFANTS (2 years or less)
Have you ever adopted from HCPAP?
If yes, when?
Do you still have the pet?
Was the pet altered?
Please list all the companion animals you have been guardian to in the last 5 years.
What type of food do you feed:
Amount of food:
How often do you feed:
What Veterinarian(s) care for and vaccinate your pet(s)?
NAME:
VET CLINIC:
PHONE NUMBER:
Why do you wish to adopt a companion at this time? (Please explain).
Have you ever done any of the following:
Given away an animal?
Lost or stolen an animal?
Turned an animal into a shelter or rescue group?
If you answered yes to any of the questions above, please explain:
Do you own or rent your home?
What type of housing do you live in? (please circle)
House Condo/Town home Mobile home Apartment
If you rent, please give the name and telephone number of the landlord or rental agent so we may verify
that pet guardianship is permitted.
NAME:
RENTAL AGENCY:
PHONE:
Does anyone in your household have allergies?
Is someone home during the day?
Who?
How many hours will your new companion be alone?
Where will your new companion be kept during………..
The day:
At night:
When you travel:
Do you have a fenced yard?
If NO, are you willing to fence?
If YES, what type of fence and height?
Do you currently have a plan to have a doggy door?
How much time to you realistically have each day to exercise and play with your new companion?
Because it is very stressful for an animal to go from home to home, we hope to place each one in a caring
home for the rest of his/her life, which could take up to 18 years or even more. Are you prepared to
make this commitment?
What will happen to the dog if you have to move?
What if you move to a place that does not allow pets?
Your new pet may take several weeks to fully adjust to you and your home. How would you ease the
adjustment?
Are your pets current on vaccinations?
If you have cats, have they been exposed to dogs?
Are your cats de clawed?
If you answered YES, to the previous question, then why?
What kind of dog behavior do you find unacceptable?
How would you handle these kinds of behavior?
Do you “believe in” spaying and neutering?
If you answered NO, please explain:
How much do you estimate it will cost per year to vaccinate, feed, and properly care for your new
companion?
What would cause you to return this dog to HCPAP?
Please provide 2 references. (Please do not include relatives or your veterinarian)
NAME:
PHONE:
NAME:
PHONE:
Completion of this application form does not guarantee that HCPAP will place one of our rescues in your
care. Completion of this application authorizes HCPAP and/or a representative of HCPAP to verify any and
all information contained herein, including verification of medical records or any present or prior pets in
your care. All adoptions are at the sole discretion of Hampshire County Pet Adoption Program (HCPAP).
By signing this application, I certify that all information is true and any false information may void this
application. I also certify that this animal will reside with me at the given address in this application.
_____________________________________________ _______________
APPLICANT and SOLE GUARDIAN of Animal to be Adopted Date
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| PLEASE FEEL FREE TO PRINT OUT THIS COPY OF OUR APPLICATION AND BRING IT TO PETSMART IN WINCHESTER ON SATURDAYS BETWEEN 11:00 A.M. AND 4:00 P.M. |
| "Hero's Dream" JIM BRICKMAN |