Primary caregiver's name *

First Name

Last Name

Secondary caregiver's name

First Name

Last Name

Phone *

(###)

###

####

What is your preferred method of contact? *

Text

Phone

Email

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Status of residency: *

Own the home

Rent the home

Live with family or friends

Other (please let us know of your living situation in Additional Comments)

Date of birth *

MM

DD

YYYY

What companion animals do you currently have? *

Please check all that apply.

Dog

Cat

Rabbit

Guinea pig

Hamster/Mouse/Rat/Gerbil

Reptile

Other (please specify in Additional Comments)

None

What companion animals have you had in the past? *

Please check all that apply

Dog

Cat

Rabbit

Guinea pig

Hamster/Mouse/Rat/Gerbil

Reptile

Other (please specify in Additional Comments)

None

Do you have a veterinarian for the animal? *

Yes

No, I need a recommendation.

I approve HHSAR to complete a background check if they feel it is necessary. *

This is part of our process to ensure our animals go to great homes. We do not do a credit check.

Yes

No

We at times request a home visit prior to approving an adoption. This would be a one time visit at your convenience. *

Yes

No