Adoption Application - Feline/Canine

Middleburg Humane Foundation (MHF)

Canine/Feline Adoption Application

To help you find the right companion animal, we ask that you answer the following questions. These questions help us determine the best match for you and your family. Please note that all adults in the household must participate in the selection of the animal and agree on the adoption. MHF reserves the right to deny adoption for any reason at its sole discretion, and is not obligated to state any reason for such denial.

First name:
Last name:
Email address:
Address 1:
Address 2:
City:
State:
Zip code:
Home Phone:
Work Phone:
Cell Phone:
Please describe the pet you wish to adopt, i.e. name, sex, color…:
Additional information about the type of animal you are looking for:
Primary Caregiver’s Name:
Does any member of your household have allergies/animal related illnesses? Please describe.
Names and Ages of all children & other Household Members:
List Types and ages of all current household pets:
Are all of your current pets spayed or neutered?
Do you plan to declaw your adopted cat?
List previous pets and what happened to them:
How long will your pet be alone each day?
Where will your pet be kept?
Approximate size of your yard:
Type of fencing:
Please describe your home:	House
	Townhouse
	Apartment
	Farm
Do you rent or own your home?	Rent
Do you rent or own your home?	Own
If rent, landlord name and phone number:
Do you have any livestock? If yes, please list:
How did you hear about MHF/our animals?
Names of pets seen by a Veterinarian:
Veterinarian's Phone Number
Veterinarian Name:
City/State:
Account under the name of:
If you are applying for a canine, please describe what a typical day would be like in your home:
Additional information you would like us to know about you/your household:
Signature (N/A) application to be signed in person.

Middleburg Humane Foundation is a 501(c)3 nonprofit organization. All donations are 100% tax deductible. MHF continues to be entirely funded by private donations with no state or county funding. Please donate via paypal or make your check payable to: MHF and mail to MHF, PO Box 1238, Middleburg, VA 20118. Click here for other ways you can help.