Happy Valley Animals in Need
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Adoption Form
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Indicates required field
Name
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First
Last
Address
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Line 1
Line 2
City
State
Zip Code
Country
Contact Phone Number
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Email
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Occupation
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Is everyone in the household in agreement on the decision to adopt?
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Is everyone in the household in agreement on the decision to adopt?
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Yes
No
Housing Situation
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House
Apartment
Mobile Home
Other
Own or Rent
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Own
Rent
If you rent, please provide landlord name and contact number
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Which animal are you interested in adopting?
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How many adults live in the household?
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How many children live in the household?
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Ages of children?
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Is anyone in your house allergic to animals?
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Yes
No
Does anyone in your home have any health issues?
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Yes
No
If yes, please describe
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Do you own any other pets?
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Yes
No
If yes, are they fixed?
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Yes
No
Ages and breed of your other pets?
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Do any of your pets have any current health issues?
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Yes
No
Current Veterinarian and contact number
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How many pets have you owned in the last five years?
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What happened to your last pet?
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Are you willing to allow us to do a home check?
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Yes
No
If interested in adopting a dog, please answer the following questions
Do you have a fenced yard?
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Yes
No
Do you have a kennel run?
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Yes
No
If no, how will exercise/toilet be handled?
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Do you live near a high traffic road?
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Yes
No
Where will dog spend most of each day?
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Indoors
Fenced Yard
Crate
Basement/Garage
Kennel
Other
Where will dog sleep?
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Indoors
Fenced Yard
Crate
Basement/Garage
Kennel
Other
How many hours will dog be alone each day
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Less than 2
2 - 4
4 - 8
Greater than 8
Additional Info
Use this space to add additional information on your home
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Please retype you name with today's date (to serve as electronic signature)
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Submit