Adoption Application Adoption Application for Animals in UHA Foster Congratulations on starting your journey to bring a wonderful new member of the family home! We applaud you for being part of the rescue community, and our trained adoption coordinators will help you find the perfect dog for your lifestyle. We also have this application in PDF form, which you may download and fill out on your computer and email to firstname.lastname@example.org: Download Adoption Application PLEASE NOTE: This application is for our foster dogs or cats only. If the animal you are interested in is located at the shelter, please contact the adoption coordinator listed on the posting for adoption information or call or visit the shelter directly at 4275 Elton St, Baldwin Park, CA 91706, (626) 962-3577. Acknowledgement (required)*I have checked that this animal is in foster with UHAThis animal is at the shelterI don't know the status of this animalIf your animal is at the shelterUHA does not house any animals except those in foster. Please call the shelter at (626) 962-3577 or visit in person at 4275 Elton St, Baldwin Park, CA 91706 to ensure your animal is available. This Application is for aDogCatName of Dog/Cat you are Interested in:Applicant InformationYour Name:* First Last Age*Name of Spouse or Partner: First Last Name of Roomate(s) (if applicable) First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Primary Phone*Alternate PhoneEmail OccupationSpouse or Partner OccupationWork ScheduleSpouse or Partner Work ScheduleNames of all Persons Living in Your Household, Their Relationship to You, and their ages:Please tell is a little bit about yourself and why you want to adoptDoes EVERYONE in your family want to adopt?YesNoPlease name a personal reference and his/her relationship to you:RelationshipPhoneHomeType of Dwelling Home Condo Apartment Rent or Own I own my home I rent my home/apt I live in Military housing If you live in a condo or apartment, what are the association's rules about pets?Do you have the landlord's permission to have a pet?yesnoLandlord's name and phone numberYour home has 1 story 2 stories 3 stories If adopting a dog, do you have a pool?yesnoIf you have a pool, is it fenced?yesnoHow do you introduce a dog to a pool?Would you object to an inspection of your home by a rescue volunteer?yesnoYour Companion AnimalsDo you have the financial means to spend hundreds or even a few thousands of dollars on veterinary care for your pet should the need arise?yesnoDo you currently have a cat?yesnoName and Breed of Current Cat(s)Age of Current CatHow long have you had the cat?Do you presently have a dog?yesnoName & Breed of Current DogAge of Current DogHow long have you had a dog?Sex Altered?YesNoHow and Why Obtained?Have you had dogs prior to your current dog?yesnoHave you had cats previously?yesnoBreed of Previous CatSex Altered on Previous Cat?yesnoHistory of Previous Catgave awaysoldlosttook to pounddied (please include reasons)other (please explain)Additional Details for Previous CatBreed of Previous DogAge of Previous DogSex Altered on previous dog?yesnoHistory of Previous Doggave awaysoldlosttook to pounddied (please include reasons)other (please explain)Additional Details for previous dog(s)Have any of you dogs/cats every had puppies/kittens?yesnoIf yes, bred for (check all that apply) fun profit show accident Has any member of your family every experienced animal-related allergies?yesnoHave you ever trained a dog in obedience class?yesnoDo you have other pets?yesnoHow many other pets do you have?What species?Where do you keep these other pet(s)?How long have you had these pets?If you have a cat, is it declawed?yesnoPlease include the name and contact details for your veterinarianWho would be responsible for your pet's care?What is your primary reason for adopting?Where will your new dog or cat sleep?How many hours/day will your new dog or cat be left alone?Where will the dog/cat be left when you are away from home?indoorsoutdoorsotherIf outdoors:in the yardon the patioin a kennelin the garageif other, where?Do you have a pet door?yesnoIf a yard, is it fenced and how high is the fence?Please indicate if the fence if wood, chainlink or another material:Have/would you use a pet-sitter or pet daycare center?yesnoWhen home, pet will be:always indoorsmostly Indoorsalways outdoorsmostly outdoorsPlease upload a photograph of the area where your pet would sleep (jpeg or gif files only)Accepted file types: jpg, jpeg, gif.This can also be emailed to us later if you don't have a photo right now. Please keep file sizes under 1MB if possible.If pet will be outside at all, what outside space if available? garage dog run fenced yard unfenced yard patio balcony other if other, please describe:Please upload a photo of your yard (jpeg or gif only please)Accepted file types: jpg, jpeg, gif.This may be emailed to us at a later date and is not required to complete this application. Please keep file sizes under 1MB if possible.How do you plan to handle the pet's exercise needs?Do you travel a great deal?yesnoIf yes, how often and how long at a time?When you travel, how do you intend to provide for the pet while you are gone?If a pet became destructive to your home, what would you do?Do you have any "musts" for a pet to be able to fit into your life?Do you feel obedience training makes a dog a better companion?yesnoIf necessary, are you willing to attend obedience classes at your expense?yesnoUnder what circumstances would you not keep the dog or cat? (check all that apply) divorce family illness moving new baby pet grew too big new job chewing kids ignore digging biting pets don't get along barking shedding medical bills allergy not obedient housetraining problem other please explain:What provisions would you make for your pet if you had to move?What would you do if the dog grew bigger than expected?return to the rescuetake to the shelterkeep outsidebe glad there is more to love!Is there anything else you would like to tell us about yourself or your home environment?Digital Signature*To sign with your digital signature, please enter your birth month in the box above. NameThis field is for validation purposes and should be left unchanged.