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2. CITY OF HENDERSON ANIMAL CENTER PRELIMINARY ADOPTION APPLICATION
4. The adoption of an animal should never be impulsive, but rather a well thought out decision made by the entire family/household and always with the best interest of the animal in mind. The goal of the Henderson Animal Center is to place animals into permanent, responsible homes. The Director reserves the right to refuse an adoption to any applicant if it appears it is not in the health, safety, and welfare of the animal or the public.
6. Animal Name
8. Species
14. Adopter Full Name
16. Spouse Full Name
18. Address1
20. Address2
22. City
23. State
24. Zip
26. Contact Number
28. Email Address
30. If renting your residence, please provide the name and phone number of your landlord. We may contact them to verify that they accept the size/breed of animal you wish to adopt. If you own your home, please check the box.
32. Own Home

    1. Yes
    2. No
34. Landlord Name
36. Landlord Phone Number
40. If you are planning to adopt a dog, do you have a fenced yard?
    -- Select One --Yes No
42. (Note: The City of Henderson reserves the right to complete a yard inspection prior to adopting a dog from our facility. This may be required for any size dog.)
44. If you are planning to adopt a cat, is it going to be strictly indoor?
    -- Select One --YesNo
46. What are the ages of the children in your household?
48. Do any members of your household have allergies specific to animals?
    -- Select One --YesNo
50. Have you or any member of your house hold ever been charged with cruelty to animals?
    -- Select One --YesNo
52. Would you consider adopting an animal that has a treatable medical condition?
    -- Select One --YesNo
56. Please tell us about your family’s current pets: (If none, please write none)

    Please include Name, Breed, Color, Age, Sex, Spayed or Neutered status and Vet Clinic Name for each current pet. 

58. If you do not currently have any pets, but were a pet owner at one time, please tell us about your family’s past pets: (If none, please write none)

    Please include Name, Breed, Color, Age, Sex, Spayed or Neutered status and Vet Clinic Name for each past pet. 

60. What is the name of your current veterinarian?*
62. What is the contact number for their veterinary clinic?*
64. Please read and sign the following statement: I certify that the information of the application is true and correct. If I am approved by Henderson Animal Center to adopt an animal, I agree to be responsible for providing proper shelter, food, water, exercise, medical care and humane treatment at all times and to abide by the animal laws in the jurisdiction in which I reside.
66. Adopter Full Name*
Leave This Blank:


68. 1. Receive an email copy of this form.
69. Email address

    This field is not part of the form submission.

70. Submit Submit and Print

* indicates a required field