P. O. Box 2772 * Baytown, TX 77522-2772
I am interested in adopting a: Dog Puppy Cat Kitten
I would like to adopt a:
Name/Names of the animals your are interested in adopting:
Why are you interested in this/ these particular Pet(s)?
Is this your first experience with a pet? Yes No
Please check any of the following reasons you wish to adopt a pet (select all that apply):
Watchdog Companion Barn Animal Breeding Hunting Family Pet Guard Dog for Business Companion for another pet Child's Pet Other
If other, Please specify
When home alone, the animal will be (select all that apply):
In a crate In an outdoor kennel or pen Loose indoors Tied up outdoors Other Loose outdoors
If other, Please Specify
Do you own any pets at the present time?
How many animals have you owned in the past 5 years? Dogs: Cats:
What other pets have you owned:
What happened to those pet? (Be specific, include name, breed, ages, health, died of old age, fatal disease, sterilized, hit by car, stolen, disappeared?)
Have you ever given up an animal? Yes No If yes, please state reason:
Please provide your Veterinarian's contact information
Do you currently reside in a: Do you own or rent your home?
Does your residence have a pool Yes No
If yes, does the pool have a fence or security barrier around it? YesNo
If you rent, does your lease allow pets? Yes No
If you rent, what is your landlord's name?
How many years have you lived at the above address?
How many people live in your household?
Do all of the adults living in the residence know that you plan to adopt? Yes No
If there are children in the household, what are their ages?
Is anyone in your household allergic to animals? Yes No
Is your new pet going to be an indoor or outdoor pet?
What type of preventative do you use for fleas? For Heartworms?
Do you have a dog-door? Yes No
Is your yard fully fenced? Yes No How many feet high is the fence?
What is your fence made of (select all that apply):
Wood Chain link Plastic Horse panels Chicken wire Barbed wire Smooth wire
What will you do with this pet if you move or become financially/ physically unable to care for the animal?
How did you hear about BHS and/or this Pet Adoptathon?
Mail to: BHS, P.O. Box 2772, Baytown, TX 77522-2772