HCPAP Application
Please remember that adopting an animal is a serious commitment. Your new companion may take days, weeks or even months to settle into their new environment. Your commitment will require tons of attention and love. You are responsible for their life and providing them with proper care. 
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Email *
Name of Primary Applicant  *
Name of Secondary Applicant (Spouse / partner) *
Age of Applicant  (If applying with spouse/partner, please provide both) *
Email Address *
Home Phone Number  *
Cell Phone Number *
Work Phone Number *
Street Address  *
City, State, Zip code  *
Can you present current identification with your current address listed?  *
If you have not resided at the provided address for at least 2 years, please provide previous address. 
Employer (if applying with spouse/partner, please provide both) *
Have long have you worked there?  *
Number of Persons in Household *
Number of Persons under the age of 18 (please provide specific ages as well) *
Have you ever adopted from HCPAP?  *
If so, when? Do you still have the pet? 

Please list all companion animals you have been guardian to in the last 5 years. Please include type of pet, name of pet, age, sex, spay/neuter status, indoor/outdoor, where the pet is now. 


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Are all of the pets listed above spayed and neutered?  *
What type of food do you feed your pets? Please include amount and frequency.  *
Are your pets current on vaccinations?  *
If you have a dog (s), do they receive monthly heartworm medication?  *
Which heartworm prevention do they receive? 
If you have a dog(s), do they receive monthly flea/tick preventatives?  *
Which flea/tick prevention do they receive? 
If you have a dog(s), how do they generally behave with other dogs?  *
If you have a cat(s), have they been exposed to dogs?  *
Please list the Veterinarian(s) that care for and vaccinate your pet(s).  Please provide vet clinic, city, state and veterinarian's name. *

If you do not have any pets, what veterinarian do you plan to use for your new companion? Please provide vet clinic, city, state and veterinarian's name. 

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Have you ever given away an animal? If yes, please explain.  *
Have you ever lost an animal? (got loose, ran away or stolen an animal?) If yes, please explain. *
Have you ever surrendered an animal to a shelter or rescue group? If yes, please explain.  *
What type of housing do you live in?  *
Do you own or rent your home?  *

If you rent, please give the name and telephone number of the landlord or rental agent so we may verify that pet guardianship is permitted.

Does anyone in your household have pet allergies?  *
Is someone home during the day? If yes, who?  *
How many hours will your new companion be alone?  *
Where will your new companion be kept during the day, night and when you travel?  *
Does your home have a yard?  *
Do you have a fenced yard? If no, please provide your plan for bathroom breaks.  *
If you have a fence, please provide the type, height and estimated size.  *
Do you have a doggy door or plan to get one? *
How much time do you realistically have each day to exercise and play with your new companion? *

Because it is very stressful for an animal to go from home to home, we hope to place each one in a caring home for the rest of his/her life, which could be 15 years or even more.

Are you prepared to make this commitment? Please explain your answer.  

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What will happen to the dog if you have to move?  *
What if you move to a place that does not allow pets?  *

Your new pet may take several weeks to fully adjust to you and your home. How would you ease the adjustment? Please explain. 

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What kinds of dog behavior do you find unacceptable?  *
How would you handle these kinds of behaviors? Please explain.  *
Do you "believe in" spaying and neutering? Please explain your answer.  *

How much do you estimate it will cost per year to vaccinate, feed and properly care for your new companion? 

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Why do you wish to adopt a companion at this time? Please explain.  *
What would cause you to return this dog to HCPAP?  *
How did you hear about our rescue?  *
Is there a certain dog (s) in our rescue that you are specifically interested in?  *
Reference Number 1 (Name and Phone Number)
Please do not include relatives or your veterinarian.
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Reference Number 2 (Name and Phone Number)
Please do not include relatives or your veterinarian.
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If you adopt a dog from us, we would love to see picture updates! It means a lot to us and encourages future homes to adopt from us.
Do you give consent for us to post update photos on our social media? 
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Completion of this application form does not guarantee that HCPAP will place one of our rescues in your care. Completion of this application authorizes HCPAP and/or a representative of HCPAP to verify any and all information contained herein, including verification of medical records or any present or prior pets in your care. All adoptions are at the sole discretion of Hampshire County Pet Adoption Program (HCPAP).

By signing this application, physically or electronically, I certify that all information is true and any false information may void this application. I also certify that this animal will reside with me at the given address in this application. I understand that I must return the dog(s) to HCPAP if the adoption was not a good fit, or I cannot continue providing proper care for the dog(s). I also understand that if the return is within 30 days of the adoption date, the adoption fee will be refunded. I understand that HCPAP is not responsible for any costs associated with the care of the dog(s) after the adoption date. 

Please electronically sign and date below.

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A copy of your responses will be emailed to the address you provided.
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