Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastWhich animal are you interested in adopting? *Are you 18 years old, or older? *YesNoPlease provide your driver's license number *Primary Phone *Physical Address *Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCity/County of Resident *How long have you lived at this address? *Are you employed? *YesNoWhere do you work? *What are your hours? *Where do you perform your job? *Do you own or rent your residence? *OwnRentPlease provide the name and phone number of the owner of the property/leasing agent *Is your name on the lease? *YesNoHow long have you lived here? *Type of dwelling? (House, apartment, mobile home, etc.) *Is there a fence? *YesNoWhat type of fence? *How tall is your fence? *Do you anticipate any major life changes in the next year? *YesNoWhat sort of changes? *Who will be responsible for this pet besides you? * the name rescue How much money are you expecting to spend annually for pet expenses and vet expenses? *How do you plan to exercise your new pet? *Where will your new pet be kept? *Outside onlyOutside mostlyInside onlyInside mostlyInside/OutsideAre you willing to secure behavioral training after adoption if needed for your new dog? *YesNoI’m not adopting a dogDo you currently own pets? *YesNo Please provide the following for each pet you currently own Type of pet *Date you first owned this pet *Is the animal sterilized? *YesNoIs the animal current on vaccines? *YesNoIs the animal current on feline leukemia/aids testing (cats)? *YesNoN/AIs the animal current on heartworm testing (dogs)? *YesNoN/AIs the animal kept on monthly heartworm preventative (dogs) *YesNoN/A Add Remove Have you owned pets in the past? *YesNo Please provide the following for each pet you've owned in the past Type of pet *Date you first owned this pet *Date you last owned this pet *Is the animal sterilized? *YesNoWas the animal current on vaccines? *YesNoWas the animal current on feline leukemia/aids testing (cats)? *YesNoN/AWas the animal current on heartworm testing (dogs)? *YesNoN/AWas the animal kept on monthly heartworm preventative (dogs) *YesNoN/A Add Remove Do you currently have a veterinarian? *YesNoPlease provide the name and contact phone number for your current vet office. *If you don't currently have a veterinarian, have you had one in the past? *YesNoPlease provide the name of the vet office and a contact phone number. *Are records for your current/prior pet(s) housed at another vet office as well? *YesNoPlease provide the name and contact number for the other vet office. *Have you ever adopted from a rescue organization? *YesNoWhich rescue organization? *Have you ever been charged with and/or convicted of animal, cruelty, neglect, or abandonment? *YesNoHow did you hear about this animal? *Please provide the names and contact phone numbers for two references who are not relatives.Reference 1 Name *FirstLastReference 1 Phone *Reference 2 Name *FirstLastReference 2 Phone *Verification and Signature:Do you understand that you will only be contacted by Hanover Humane's Adoption personnel only if your home is a good fit for the animal associated with this application? *I understandDo you understand that, if the animal is not placed in your home, the reason for not placing the animal in the home will not be divulged to you so that the integrity of Hanover Humane's adoption process may be maintained? *I understandDo you agree to the terms of Hanover Humane's Adoption process as presented in these application materials? *I understandType your name and today's date. This will serve as your signature. *Submit
