Adoption Application

NMHPU Adoptions

Other Adoptable Pets in Utah

Losers Need Love Too!

Hearts & Hugs Needed

Pet Name (optional)
Would you like to adopt a Dog or Cat?* CatDog
First Name*	Last Name*
Address*
City*
State	Zipcode*
Phone*
Employer	Work Phone
Email*
Age*
Please list in detail the animal you are looking for:
Please list all the members in your household, including ages:
Does anyone in your household have allergies? If yes, please list the type of allergies:
Please list all the pets currently in your household, including breed and age:*
Are they all current on vaccines? YesNo
Are they all spayed or neutered?* YesNo
Please list the pets that are no longer in your care and describe what happened to them:*
Do you own a home, rent or live with parents?* OwnRentParents
If you rent, list the landlord's information:
Landlord's Name
Landlord's Phone
Where will your new pet be kept during the day? Check all that apply: HouseYardGarageDog Run CrateTie-Out / ChainPatioBasement
Where will your new pet be kept during the night? Check all that apply: HouseYardGarageDog Run CrateTie-out / ChainPatioBasement
If you are adopting a cat, do you plan on having your cat declawed?* YesN/A No
Do you have a dog door?* YesNo
How many hours a day will your new pet be alone?*
How many hours will your new pet be outside? (dogs and cats)*
If you are adopting a dog, what type of fence do you have?*
How will you transport your dog? (check all that apply) Crate/KennelBack of truck Car
How do you plan to train your new pet?
How will you exercise your new pet?
Under what circumstances would you give up your animals?
Besides aggression, which behavioral problems are you willing and able to cope with? Check all that apply: ChewingScratching of furniture / carpetingHidingEscaping from house / yard DiggingPlay bitingBarkingHouse soiling / litter box problems JumpingShynessSeparation Anxiety
Why do you want to adopt this pet? Check all that apply: Child's PetWatch / Guard DogMouser / Barn cat HuntingCompanion for another pet
Who is your current veterinarian?
How long have you been at your current residence?
How long have you been at your previous residence?
Have you ever had to move while you owned a pet?* YesNo
If yes, what happened to your pet(s)?* Took withLeft with friend / familyTook to Humane Society / Shelter
I understand that this application does not reserve this animal nor does it mean I am eligible to adopt from this agency. I understand that the adoption agents will do their very best to match this animal with my lifestyle and that if the agent deems this adoption as a non-match that it does not exclude me from adopting animals in the future. I understand that the adoption agent has the right to deny, reject, decline, refuse or postpone any adoption at any time during the interview. I understand that the information I have given to be true and that any false information will result in termination of this adoption agreement. As a condition of adopting this animal, I understand that the Coalition For Animals dba No More Homeless Pets in Utah cannot guarantee the health, training, or temperament of the animal(s) I am adopting. I, hereby for myself, heirs, administrators and assigns, fully, irrevocably, and unconditionally release and agree to hold harmless the Utah Coalition for Animals dba No More Homeless Pets in Utah and their individual members from any and all known or unknown, anticipated or unanticipated, suspected or unsuspected and/or fixed, conditional, or contingent actions, causes of actions, charges, suits, debts, demands, claims, contracts, covenants, liens, rights, liabilities, losses, royalties, costs, expenses, including, without limitations, attorney's fees or damages, including but not limited to any medical costs, damages to property, persons, or other pets, of every kind, nature, description, at law or in equity, in connection with or arising from my adopting said animal.
I have read and understand the above agreement



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