South Hamilton Animal Alliance Adoption Application
Name
Name of Spouse
Street Address
PO Box
City, State, Zip Code
Home Phone
Cell Phone
Email address
Your Age or Date of Birth
Which pet are you interested in adopting?
Do you live in a house, condo, apartment, or mobile home?
Do you own or rent?
If you rent, please give the name and phone number of your landlord.
Do you have a fenced in yard?
Are you in town or on an acreage?
Does anyone in your household have allergies to pets?
Are you or your spouse in the military?
Your Current Place of Employment is
Your work phone number is
Your spouse's place of employment is
List current pets in household (names, breeds, ages, spayed/neutered, indoor/outdoor?
List recently deceased pets please
Are your current/recent pets up to date on vaccines?
Are your current/recent pets spayed/neutered?
If any of them are not spayed/neutered, please explain why
Are your current/recent dogs on heartworm prevention pills?
Will the adopted pets be indoor, outdoor or, both?
If outdoors, how will it be contained? Ie fence, tie-out, kennel, free roam, leash
Name, Address, and Phone number of your current Veterinarian
Will this pet be introduced into a household with children? List ages of children
Is it okay for us to contact your veterinarian regarding your current or recent pet's health history?Yes
No
Use the space below to list a personal reference, other than your vet, who knows how you care for your pets.
Use the space below to list any special circumstances or information which you think is important in our consideration of you as a potential adopter.
If you are not from Iowa, you will need to either travel to Iowa to come get the pet you are interested in, or prepay shipping and transport (estimate $250 - $450) in addition to the adoption fee, as well as pay for the kennel which is yours to keep. Do you agree to this?I am from Iowa
I am not from Iowa, but will drive to pick up
I plan on shipping the pet and agree to above
Do you recognize that adoption of a pet is a commitment of possibly 10-20 years?yes
no
If this pet is too young to have been spayed or neutered when you adopted it, do you agree to have this procedure done by 6 months of age?Yes
No
If the pet you are adopting is not spayed/neutered. you have the option of returning it to Jewell Animal Hospital for the procedure included in the adoption fee. If I take it to my veterinarian for the procedure it is at my expense and will not be reimbursed. If a spay/neuter deposit was left, it will be refunded after proof of the procedure is submitted.Yes, I understand and agree.
I do not agree to this.
Do you agree to have this pet's vaccines updated as recommended by your veterinarianYes
No
If this adopted pet is a dog, do you agree to keep it on heartworm pills from April to November or give them year round?Yes, I will give monthly heartworm prevention.
I do not agree to this.
I am adopting a cat
Do you agree that if for any reason this pet is not working out in your household, that you will contact us immediately, and return it to our facility?Yes, I agree to return the pet
No, I do not agree
Do you understand, that even if the pet is returned, your adoption fee is considered a donation is will not be refunded?Yes, I understand
No
Do you agree to have your veterinarian examine the adopted pet within 3 days of the adoption, and to have a copy of the record faxed or mailed to our facilty?Yes, I agree and will get an appointment with vet
No, I do not agree
Do you realize that keeping your pet current on rabies vaccine, even indoor pets, is required by law?Yes, I understand and will keep them currnent
No, I didn't realize, but will update my pets
No, I will not vaccinate my pets
Where did you hear about our adoptable pets?Petfinder.com
1-800 Save a Pet .com
Pets911.com
Jewell Animal Hospital Sign
JewellVetOnline.com
Newspaper
Petsmart Adoptathon
Pet Expo in Des Moines
Filling out this application does not mean the pet in question is yours, or being held for you. We will notify you if you are chosen to adopt the petI understand
