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361-729-8186
1308 Myrtle St | Fulton, TX 78358
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Adoption Application
Fill out the online form or download and print an application
CLICK HERE TO DOWNLOAD AND PRINT AN APPLICATION
Please enable JavaScript in your browser to complete this form.
Name
*
First
Last
Address
*
Address Line 1
Address Line 2
City
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State
Zip Code
Email
*
Phone
*
Name of the animal you are interested in adopting
*
Number of Adults in the home
*
Number of Children in the home
*
Do you own or rent?
*
Own
Rent
Landlord Name and Phone Number
*
Landlord will be contacted for approval prior to any adoption. We welcome adopters who rent, or live in an apartment or condo. We want to alert you that some landlords and or management companies have limits on size, weight, breed or number of pets, and may require a pet deposit.
Type of Home
*
Single Family Home
Apartment
Condominium
Mobile Home
We welcome adopters who rent, or live in an apartment or condo. We want to alert you that some landlords and or management companies have limits on size, weight, breed or number of pets, and may require a pet deposit.
Current or Past Pet #1 Name and Type
Do you still have this pet? If not what happened?
Was Pet #1 Spayed or Neutered
Yes
No
Is or Was Pet #1 Current on Vaccinations?
Yes
No
Current or Past Pet #2 Name and Type
Do you still have this pet? If not what happened?
Was Pet #2 Spayed or Neutered
Yes
No
Is or Was Pet #2 Current on Vaccinations?
Yes
No
Current or Past Pet #3 Name and Type
Do you still have this pet? If not what happened?
Was Pet #3 Spayed or Neutered
Yes
No
Is or Was Pet #3 Current on Vaccinations?
Yes
No
Veterinarian's Name and Phone Number
I give permission for the Humane Society and Adoption Center of Rockport-Fulton to request and verify records from my veterinarian.
Initials
Type of fencing at your home
*
None
Chain Link
Wood
Invisible
Other
Fence Height (in feet)
Is someone home during the day?
*
Yes
No
How many hours will the animal be alone?
*
How do you plan to exercise your pet?
*
Have you had to re-home a pet previously?
*
Yes
No
Why did you have to re-home a previous pet?
*
We are committed to positive reinforcement training, can you continue with the same approach?
*
Yes
No
Do you understand that an animal’s behavior in the shelter may be different than the behaviors exhibited in the home?
*
Yes
No
It may take your new pet six weeks or longer to adjust to your home, sometimes longer if other pets are involved. Are you prepared to allow this much time to adjust?
*
Yes
No
Would you object to an inspection of your property by our staff?
*
Yes
No
Please provide the name and phone # of the person or persons who will take responsibility for your pet in case of a major life altering event such as: household changes, illness, or death.
I understand that if I have to return my pet to HSAC, I agree that I will pay a surrender fee of at least $50.00
Initials
I understand that this is an adoption, not a sale, and the HSAC of Rockport-Fulton reserves the right to refuse or rescind any adoption. I understand that if approved, I will have 3 days to pick up the animal unless prior arrangements have been made. Signing below, I certify that the information I have given is true and that any misrepresentation of facts may result in my losing the privilege of adopting a pet.
Initials
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