HRM City Pound

Homeward Bound City Pound
201 Brownlow Avenue Unit #9
Burnside Industrial Park
Dartmouth NS
B3B 1W2
(902) 407-SAVE (407-7283)
www.citypound.ca
[email protected]

If you rather download an application in pdf format to print out,
fill in and bring in or send in, you can do that here

ONLINE ADOPTION APPLICATION FORM

Date Submitted:

Name of animal you are interested in:

Name:
Address:
City:	Province:	Postal Code:
Telephone:	Email Address:

Household Members Under 8: 8-17: 18 and over:

Who will be primarily responsible for the care and supervision of the animal?

Do any of your household members have allergies to pets? Yes No

Have you discussed the responsibilities of owning the pet with the entire family? Yes No

Do all household members agree to adopt? Yes No

Are any household members pregnant? Yes No

How active is your household? Quiet Average Very Active

Home Ownership; do you? Rent Own Live with family

If renting; name of Landlord:		Landlords Phone: Landlord Email:
Please call your landlord and let them know we will be calling in the next few days.
Number of years at this address:

What type of home you live in?

Apartment House Condo Townhouse Mobile Home

LIST ALL PETS CURRENTLY LIVING IN YOUR HOUSEHOLD No current pets

Species (cat/dog etc)	Breed	Gender	Age	Spay/Neuter	Indoor/Outdoor	Last Vaccination	Licensed?
		Male Female		Yes No	In Out	Yes No	Yes No
		Male Female		Yes No	In Out	Yes No	Yes No
		Male Female		Yes No	In Out	Yes No	Yes No
		Male Female		Yes No	In Out	Yes No	Yes No

LIST ALL PETS THAT YOU OWNED PREVIOUSLY (past 5 yrs)				No pets as an adult
Species (cat/dog etc)	Breed	Gender	Spay/Neuter	Owned for how long?	Age of pet at the time	Why do you no longer have the pet?
		Male Female	Yes No
		Male Female	Yes No
		Male Female	Yes No
		Male Female	Yes No
		Male Female	Yes No
		Male Female	Yes No

Do you have a Veterinarian?	Yes No
Veterinarian Name
Name of Clinic
Address
Telephone Number
May we contact your vet?	Yes No
Please call your veterinarian and give permission for us to call and inquire about the vet care of your animals past and present.

What are you interested in adopting?
Dog :	Cat:	Rabbit:	Other:	Explain other:
Baby:	Young:	Adult:	Senior:

Would you consider adopting a pet with special needs? Yes No

Reason to Adopt?
Companion for Self:	Companion for other pet(s):	Hunting / Herding:
Companion for Children:	Guarding	Mouser:
Other:

How long have you been considering / looking for a pet?
How much have you budgeted per year for the new pet?
Are you willing to commit the next 10-15 years to this pet?
How much time are you willing to give a pet to adjust to it's new home?
How many hours each day will yor household be without people?

Where will the pet be kept?
During the daytime?
During the nighttime?

For what problems do you feel unprepared?
House soiling?	Not good with other animals?	Not good with children?
Excessive chewing?	Excessive grooming needs?	Excessive activity level?
Biting?	Medical issues?	Confinement issues?
Other?

What will you do with the pet when you go on vacation?
What will you do with the pet if you move?
Are you familiar with animal control laws in your area?	Yes No

For what reasons might you return your pet?
A new job:	Kids getting busy:	Divorce:	Moving:
A new Baby:	Too expensive:	Bad habits:	None:

Dogs
If the dog will be kept outside, what type of confinement?
Fenced yard or pen	Chain	No confinement
Do you plan to attend dog training classes?		Yes No
How many times per day will the dog be walked?
I want a highly enthusiastic (in showing their love) dog.		Yes No
I want a dog that is very laid back.		Yes No
I want a very active dog.		Yes No
I want a very playful dog.		Yes No

Cats
I want a cat that interacts with me regularly.	Yes No
I want a cat that plays with children.	Yes No
I want a cat that is active with ohter cats.	Yes No
I want a cat that is amused by toys.	Yes No
How many litter boxes do you plan to have?
Do you plan to declaw?	Yes No
Thank you for your interest in adopting one of our animals.