| Which animal
are you interested in adopting from HSBC? |
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| Full Name (First,
Middle, Last) : |
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| Date of Birth:
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| Email Address:
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| Street Address:
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| City:
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| State:
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| Zip Code:
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| Home Phone
Number: |
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| Work Phone
Number: |
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| Cell Phone
Number: |
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| Have you ever
been declined a request to adopt an animal by an animal rescue,
welfare or control facility? |
Yes
No |
| If you answered
yes to the previous question, please explain: |
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| Full name (first,
middle, last) and date-of-birth for each household resident over
the age of 18. Enter "none" if there is no one besides
the person listed above. |
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| Number of children
in the home under the age of 18 |
None
1
2
3
4 or more |
| Do you often
have children under the age of five visit? |
Yes
No |
| What is your
current housing situation? |
Own a home
Rent a house
Rent an apartment
Have roommate(s) |
| If you rent,
please provide your landlord's name and telephone number:
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| What pets do
you have presently? (Please list species, breed and age of each)
Enter "none" if there are no other animals in the household.
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| Are your current
pets spayed or neutered? |
Yes
No
I have no current pet |
| If you answered
"no" to the previous question, why not? |
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| Are your current
pets up-to-date with vaccinations? |
Yes
No
I have no current pet |
| If you answered
"no" to the previous question, why not? |
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| What pets have
you had in the past, and what has happened to them? Enter "none"
if you have not owned a pet before. |
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| If you adopt
this animal, how will you house him/her? |
In an outside run
Outside with a doghouse
Running loose outside
Inside our home
Fenced yard |
| Where will
your new animal spend its day? |
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| Where will
your new animal spend its night? |
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| If you are
adopting a dog, do you plan to crate him/her? If so, for what reason
and for how long? |
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| Owning an animal
can be costly. Are you prepared and able to spend approximately
$800-$1000 a year on vet bills, food and incidentals? |
Yes
No |
| Have you done
research on this type of animal (breed, temperament, grooming needs,
etc.)? |
Yes
No |
| If adopting
a dog, do you plan to take him/her to obedience training?
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Yes
No |
| Are you aware
that changing an animal's environment may cause it to have accidents?
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Yes
No |
| Who will be
responsible for feeding, supplying water and exercising the animal?
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| How will you
exercise the animal and for how long? |
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| How often do
you travel? What will you do with your pet when you travel?
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| Is everyone
in the household in agreement with adopting this animal?
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Yes
No |
| Are you aware
of the adoption fee and what it includes? (If no, please refer to
our web site) |
Yes
No |
| Please provide
us with your veterinarian information, including name, clinic and
phone number. |
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| Do you have
any other information you'd like to share with HSBC?
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HSBC requires
that all animals adopted from us be housed inside the home.
All animals must be maintained in a matter that exceeds state
statutes. HSBC reserves the right to deny adoptions to anyone
without stating the reason. All applications will have background
checks done through the courts and veterinarians will be contacted.
Home visits may occur. Should any problem arise with the animal,
HSBC will be contacted. Any animal adopted from HSBC cannot
be resold.
Click the Submit
Form if you have answered all the questions honestly and to
the best of your knowledge...and if you've read the above statement
and understand it.
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