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Little Woman Home for Animals
Adoption Application
Mailing Address: Phone:
66 Evelyn Lane (936) 435-9820
Huntsville, TX 77340 (936) 662-6502
Name:______________________________________________________________________________________
Spouse or significant others name: _________________________________________________________________
Street Address: _______________________________________________________________________________
City, State, Zip:_______________________________________________________________________________
E-Mail address:_______________________________________________________________________________
Home Phone with Area Code: _______________________ Work Phone with Area Code: _____________________
Cell Phone:_________________________
I am age 21 or older:__Y / N_________
Information about the animal you wish to adopt:
Name of Animal:__________________________________________________________
Number of Animals you wish to adopt:_____________
Who will be responsible for this pet? (circle one) Self Spouse Children Other
Where will your pet be kept during the day? (circle one) Loose in house In Cage Outdoors Other_______________________________________
Where will your pet be kept in the evening? (circle one) Loose in house In Cage Outdoors Other_______________________________________
Where will your pet sleep at night?____________________________________________________
Will your pet be allowed outside? (check one) Yes________________ No____________________ _________________________________________________________
If the pet is a cat do you want to have it declawed? (check one) Yes________ No______
If yes: (check one) 2-paws_____ 4-paws______ If yes: Why?___________________________________________
_____________________________________________________________________________________________
Information about your current residence:
Do you own or rent?_________________
If your rent, Landlord's name:____________________________________________
Landlord's phone:___________________________________
Resident type: House Apt. Duplex Mobile Home Farm
How many members in household:_____________
Are there children in the household?_________
If yes, how many?____________________
Their ages:_________________________
Does anyone in the household have asthma or pet allergies?___________________________________________
Have you or anyone in the household ever been convicted of an animal related crime? Y / N
Does anyone that lives in the household smoke?___________________________________________
Pets:
Do you have any other pets currently?_____________
Are they spayed/neutered?_________
Please list name, type, breed, age, and sex of current pets:____________________________________
Have you had pets in the past? Y / N Please list types and what happened to them:_____________________________________________________________________________________
____________
Information about your veterinarian:
Name of Veterinarian:_________________________________________________________ Address:______________________________________________________________________________________________ Phone:________________________________
What name is used at the vet as owner of the pet?____________________________________________________
Will you use this vet for your new pet? (check one) Yes_____ No____
If not, who will you use?_______________________________________________
May we have permission to contact your veterinarian? Yes_____ No_____
Other:
Pets often live longer than 15 years. Are you prepared to take responsibility for this pet for it's entire lifetime?
(check one) Yes_____ No______
It may take your pet a month or longer to adjust to a new home. Are you willing to allow this much time for adjustment? (check one) Yes_____ No______
It may take your new pet and your current pets a few weeks or more to adjust to each other. A new pet will upset the established pecking order and until a new one is formed, there may be some hissing, growling, even a fight or two. Are you willing to allow your pets time to adjust to each other? (check one) Yes_____ No______
Are you adopting this pet as a gift for someone? (check one) Yes_____ No______
If your answer is yes, does the recipient know about it? (check one) Yes______ No______
Do you agree to return the pet to Little Woman in the event that you can no longer keep it?
(check one) Yes_______ No______
Are your willing to let a representative of Little Woman visit your home by appointment? (check one) Yes____ No______
Have you ever adopted from a humane organization in the past? Yes_______ No______
If yes, name of shelter or organization:_____________________________________________________
Have you ever released an animal to any other shelter? Yes_____ No______
If yes, please explain:
______________________________________________________________________________
_________ _______ ____________________________________________________________
References:
Please provide the names and phone number of two pet friendly references (neighbors, friends, etc.) Relatives may not be references
Reference #1: Name:______________________________________________________________________________________
Relationship to applicant:_________________________________________
City:________________
State:_____________
Day phone number:
Evening phone number: ___ ____________________
E-Mail Address:__________________________________________
Reference #2:
Name:__________________________________________________
Relationship to applicant:_______________________
City:____________________
State:____________ _____
Day phone number:
Evening phone number:___________________________________
E-Mail Address:____________________________ ________
By signing and sending this application, I certify that the information provided on this application is true and I recognize that any misrepresentation of facts may result in losing adoption privileges. I authorize investigation of all statements in this application and understand that veterinarians, landlords, other humane organizations, references, etc. may be contacted. I further understand that the adoption of this animal may be delayed until this information can be verified. If at any time, a representative for Little Woman and/or local authorities determine the animal is being neglected or abused, this application will be void and ownership will revert back to Little Woman.
Signature;______________________________ Date:_________________________
Little Woman Home for Animals Adoption Policy
Mailing Address: Phone:
66 Evelyn Lane (936) 435-9820
Huntsville, TX 77340 (936) 662-6502
www.littlewoman.zoomshare.com
Adopter's Name:____________________________________
Animal's Name:_____________________________________
Adoption Policy
I hereby agree to:
1. Keep and maintain the animal in a humane manner and keep it in my home or on my property. All cats adopted must be indoor cats only.
2. Take the animal to a licensed veterinarian within ten (10) days from the adoption date for a medical examination, to insure it's health.
3. If the pet is a cat, have the cat tested for FELV/FIV at its first veterinarian visit, if it has not already been tested. If the cat tests positive it may be returned to Little Woman, for special placement with a foster family.
4. Have the animal spayed or neutered by a licensed veterinarian within 10 days of adoption or when the pet reaches the age of 4-6 months, if not spayed/neutered when adopted. In the event I do not have the animal spayed or neutered within the specified time, the ownership of the animal shall revert back to Little Woman.
5. Provide any medical attention required or needed. This includes at least one annual medical check up, any vaccinations indicated and preventative medications. 6. Have the animal vaccinated against rabies as required by state law.
7. Not give away or abandon the animal. If I find myself unable to keep it, I will return it to Little Woman.
8. Hold Little Woman harmless from any incurred fees or damages caused by the animal while in my care.
9. I understand a veterinarian has treated this pet, while in the care of Little Woman and that they have taken every step possible to provide me with a healthy animal. I do agree to hold Little Woman harmless, if the pet does have an illness that went undiscovered while in their care.
10. Give permission to agents of Little Woman to visit my premises at any reasonable time to insure the compliance of this contract.
Fees paid at the time of adoption include:
1. First and possible follow up Veterinarian's examination (s).
2. Initial vaccinations and possible follow up vaccines for cats
3. Any medications the pet has been on up to the time of adoption.
4. Care of the animal while at Little Woman.
5. Socialization of the animal with humans and other pets.
Signature:______________________________________ Date:_____________________________
Print Name:________________________________________
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