| Name or description of pet for whom you are applying: |
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| Date of application: |
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| Name: |
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| Email Address: |
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| Street: |
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| City, State, Zip: |
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| Home Phone: |
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| Secondary Phone: |
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| Driver's License # and State (required by GA Dept. of Agriculture): |
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| Have you ever adopted a pet and returned it? |
Yes
No
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| Do you currently: |
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| Is your home a(n): |
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| If you rent, are pets allowed: |
Yes
No
Don't know
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| If pets are allowed, is a pet deposit required: |
Yes
No
Don't know
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| If a pet deposit is required, how much is it? |
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| If a pet deposit is required, are you able to pay it at this time: |
Yes
No
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| If you rent, please provide your landlord's name and phone number: |
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| How many adults live in your home: |
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| How many children live in your home: |
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| If you have children, what are their ages? |
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| Are any members of your household allergic to dogs/cats: |
Yes
No
Not sure
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| Are any members of your household afraid of dogs/cats: |
Yes
No
Not sure
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| Are there, or will there be, other pets in your home: |
Yes
No
Not sure
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| If other pets, how many and what kind: |
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| If other pets, are ALL of them spayed/neutered: |
Yes
No
Not sure
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| If other pets, are ALL of them current on vaccinations: |
Yes
No
Not sure
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| Have any of your pets died in the past year: |
Yes
No
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| If any pets have died, please explain how/why: |
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| Please provide your veterinarian's name and phone number for a reference: |
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| Where will your pet be kept: |
Inside only
Outside only
Both inside and outside
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| Where will your pet stay when no one is home: |
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| If your pet will be outside at any time, how will he/she be contained: |
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| If you plan on chaining your dog outside, is it legal in your county: |
Yes
No
Don't know
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| If you're applying for a cat, do you plan on having him/her de-clawed: |
Yes
No
Not sure
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| Please explain why you want this pet: |
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| Are all members of your family in favor of adopting this pet: |
Yes
No
Not sure
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| Who will care for your pet while you're out of town or on vacation: |
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| How many hours a day will you be able to spend with your pet: |
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| Do you have the time and patience to train and exercise this pet: |
Yes
No
Not sure
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| Do you understand that adopting a pet is a 15-20 year commitment: |
Yes
No
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| Do you anticipate any major life-changes (i.e., marriage, children, relocation) in the next 15-20 years that may cause you to have to re-home this pet: |
Yes
No
Not sure
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| Do you agree to contact Hightower Farm should you feel that you can no longer properly care for this pet: |
Yes
No
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| In most cases, adoption fees cannot be refunded if you decide to return this pet: |
I Agree
I Disagree
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| Hightower Farm reserves the right to inspect and assess the quality of care provided to this pet after adoption and to remove him/her from any environment deemed not to be in the best interest of the pet as disclosed in this questionnaire: |
I Agree
I Disagree
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