Adoption Application

Adoption Application
Date

Month Day Year
Date
Name of Pet Breed
Adopter Name *

First Name Last Name

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Primary Phone Number *

Area Code Phone Number
Alternate Phone Number

Area Code Phone Number
Email *
example@example.com
Date of Birth

Month Day Year
Date
Partner/Spouse Name (if applicable)

First Name Last Name
Phone Number

Area Code Phone Number
Email
example@example.com
Number of People in Household
Children in Household? Ages:
Employed?
Please List Employer
Do you rent or own? *
If you rent we have to verify you are allowed pets. Please check with them before you submit your application.
Landlord Name and Phone Number
Where will pet live?
Do you have a fenced in yard? *
Do you currently have any pets? *

Yes No
Have you had any pets in the last 5 years? *

Yes No

Please list any pets you have owned in the last five years?

Pet 1

Pet 2

Pet 3

Pet 4

Pet 5

Pet 6

Name of Pet(s)

Type of Pet(s)

Years Owned

Spayed/Neutered

Where is Pet Now?

We do require your current pets to be up to date on vaccines. Please verify before you submit application.
Vet or Clinic name and phone number
Personal Reference
Name and Phone Number
In completing this application, I hereby affirm that all information given is true and accurate to the best of my knowledge. I also acknowledge that should any of the information on this application prove false, or should I misrepresent myself in any way, my application will be denied. There is a one time, HOLD fee of $25.00 for ANY adoption. This includes sponsored animals.

We do verify current pets are up to date with vaccinations. If you rent, you have to have landlord approval. Please do not place the HOLD fee if you are unsure.
Signature *

Clear
Please note we cannot hold this pet until we recieve the $25 non refundable hold fee. Please call us at 772-589-7297 to place this hold.

Once received we will start processing your application!
HALO Extras

At HALO we make every effort to prevent the spread of fleas and ticks throughout the shelter. HALO's Pest Arrest treats monthly and rescue's receive regular bathing. However, we CANNOT guarantee that a dog or cat will be free of fleas and/or ticks when leaving this facility. For this reason we offer and strongly recommend purchasing flea control and a bath at time of adoption.
I would like to purchase Advantage (flea) medication for my new pet before coming home!

Single Application which lasts 1 month ($15) 6 month ($66 depending on size-get 2 free application when purchase a pack!)
Please have HALO bathe or groom my new pet on pick up!

Bath (includes nail trim and ear cleaning) ($20 sm. dog/$30 lrg. dog/cat)
I would like to receive a FREE estimate from HALO's Pest Arrest service for pest control-shrub-lawn care at my home!

Yes No
I would like HALO to make my new pet a Pet Tag ($5/one side $10/two side)

Yes No
I believe in HALO's No Kill mission and would like to donate to the animals!

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Adoption Application

HALO Extras