Home At Last Animal Sanctuary
PO Box 144
Salvisa, Ky 40372

Welcome to the Home At Last adoption program. We're happy that you are considering adopting an animal from us. The following information is requested so that we can assist you in the selection of a new companion. This form and consultation with a Home At Last representative are designed to help us determine if the adoption is in the animal's best interest, and to assist you in finding an animal most compatible with your lifestyle. You may also print and mail this form to the above address.

In order to be considered as an adopter you must:

• Be 21 years of age or older.
  
  
• Have identification showing your present address.
  
  
• Have the knowledge and consent of your landlord.
  
  
• Be willing to spend the time and money necessary to provide training, medical treatment and proper care for the animal.

Completion of this application does not guarantee adoption of a Home At Last animal.

Name of Applicant:

Email Address:   Phone:

Street Address: City:

State: Zip:

Describe the animal you're looking for:

Would this be your first companion dog or cat? Yes No

What kind(s) of companion animals have you had?

Which do you still have?

Have they been spayed or neutered? Yes No

What happened to the ones you no longer have?

Will your present animals adjust to a new dog/cat in the house? Yes No

Why do you want this animal?
Companion Companion for other animal Watch dog Guard dog
Personal protection Barn cat House pet
Other:

How many adults are there in your family?
How many children?
Children's ages:

Does any household member have an allergy to animals? Yes No

Is someone home during the day? Yes No

Who?

How many hours will the animal be alone during the day?

Explain:

Do you live in? House Apartment Mobile Home Other

Do you: Own Rent your home?

If you rent, may we contact the owner to obtain permission for this animal to live in your home?
Yes No

Owner's name and phone number:

Will you keep your animal up-to-date on vaccinations? Yes No

Who is your veterinarian?
Veterinarian's city or town:

If you go away for a few days, or on a vacation, who will take care of the animal?

If you must move, will you take the animal with you? Yes No

Have you ever applied to adopt a dog or cat from Home At Last in the past?
Yes No

When?

Are you willing to have a representative of Home At Last come to see where your animal will be living? Yes No

Are you willing to take responsibility for this animal for the next 10-15 years?
Yes No

Under what circumstances do you believe euthanasia is appropriate?

Please list a non-family personal reference (with phone number):

Other comments by applicant:

FOR DOGS

Do you have a completely fenced yard? Yes No

Fence height:

What kind of fence?

If not, explain:

If you drive a pickup truck, would you allow the dog to ride in the back? Yes No

Would you be willing to exercise your dog on a regular basis? Yes No

Method:

Do you have hobbies that would include your dog?

Where will the dog be kept during the day?

During the night?

FOR CATS

Will your cat be kept: Inside Outside Inside/Outside

Explain:

Will you have your cat declawed? Yes No