Adoption Application

Happy Valley Animals in Need

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Adoption Form

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Contact Phone Number *

Email *

Occupation *

Is everyone in the household in agreement on the decision to adopt? *

Is everyone in the household in agreement on the decision to adopt? *

Yes No

Housing Situation *

House Apartment Mobile Home Other

Own or Rent *

Own Rent

If you rent, please provide landlord name and contact number *

Which animal are you interested in adopting? *

How many adults live in the household? *

How many children live in the household? *

Ages of children? *

Is anyone in your house allergic to animals? *

Yes No

Does anyone in your home have any health issues? *

Yes No

If yes, please describe *

Do you own any other pets? *

Yes No

If yes, are they fixed? *

Yes No

Ages and breed of your other pets? *

Do any of your pets have any current health issues? *

Yes No

Current Veterinarian and contact number *

How many pets have you owned in the last five years? *

What happened to your last pet? *

Are you willing to allow us to do a home check? *

Yes No

If interested in adopting a dog, please answer the following questions

Do you have a fenced yard? *

Yes No

Do you have a kennel run? *

Yes No

If no, how will exercise/toilet be handled? *

Do you live near a high traffic road? *

Yes No

Where will dog spend most of each day? *

Indoors Fenced Yard Crate Basement/Garage Kennel Other

Where will dog sleep? *

Indoors Fenced Yard Crate Basement/Garage Kennel Other

How many hours will dog be alone each day *

Less than 2 2 - 4 4 - 8 Greater than 8

Additional Info

Use this space to add additional information on your home *

Please retype you name with today's date (to serve as electronic signature) *

Submit

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