Little Woman Home for Animals Adoption Application 
 
Mailing Address: 
66 Evelyn Lane 
Huntsville, TX 77340
Phone:  (936) 435-9820 (936) 662-6502 
www.littlewomanhome.org
 
Name:_______________________________________________
Spouse or significant others name: _____________________________________________________
Street Address: _____________________________________________________
City, State, Zip:_________________________________________________
E-Mail address:_________________________________________________
Home Phone with Area Code: _______________________ 
Work Phone with Area Code: _____________________
Cell Phone:_________________________   
I am age 21 or older: Yes_____ No____ 

Information about the animal you wish to adopt: 
Name of Animal:________________________________________
Number of Animals you wish to adopt:_____________
Who will be responsible for this pet? (circle one) 
Self Spouse Children Other 
Where will your pet be kept during the day? (circle one) 
Loose in house   In Cage    Outdoors Other_______________________________________ 
Where will your pet be kept in the evening? (circle one) 
Loose in house    In Cage    Outdoors Other_______________________________________ 
Where will your pet sleep at night?__________________________
Will your pet be allowed outside? (check one) 
Yes_____ No____
If the pet is a cat do you want to have it declawed? (check one) Yes_____ No____
If yes: (check one) 2-paws_____ 4-paws______ If yes: Why?___________________________________________
________________________________________________
 
Information about your current residence: 
Do you own or rent?_________________ 
If your rent, Landlord's name______________________________
Landlord's phone:___________________________________ 
Resident type: House   Apt.   Duplex   Mobile Home   Farm 
How many members in household:_____________ 
Are there children in the household? Yes_____ No____ 
If yes, how many?____________________ 
Their ages:_________________________ 
Does anyone in the household have asthma or pet allergies? 
Yes_____ No____ 
Have you or anyone in the household ever been convicted of an animal-related crime? Yes_____ No____  
Does anyone that lives in the household smoke? Yes_____ No____

Pets: 
Do you have any other pets currently? Yes_____ No____
Are they spayed/neutered? Yes_____ No____
Please list name, type, breed, age, and sex of current pets:____________________________________       ______           
                                                                                                                                                                                         
Have you had pets in the past? Yes_____ No____
Please list types and what happened to them:  ____________________________________       __________           

Information about your veterinarian: 
Name of Veterinarian:____________________________________ Address:_______________________________________________ ____________________________________________ Phone:________________________________ 
What name is used at the vet as owner of the pet? ____________________________ 
Will you use this vet for your new pet? (check one) 
Yes_____ No____ 
If not, who will you use?_______________________________________________ 
May we have permission to contact your veterinarian? 
Yes_____ No____

Other:
Pets often live longer than 15 years. Are you prepared to take responsibility for this pet for its entire lifetime? 
(check one) Yes_____ No____
It may take your pet a month or longer to adjust to a new home. Are you willing to allow this much time for adjustment? (check one) Yes_____ No____
It may take your new pet and your current pets a few weeks or more to adjust to each other. A new pet will upset the established pecking order and until a new one is formed, there may be some hissing, growling, even a fight or two. Are you willing to allow your pets time to adjust to each other? (check one) Yes_____ No____ 
Are you adopting this pet as a gift for someone? (check one) Yes_____ No____
If your answer is yes, does the recipient know about it? (check one) Yes______ No______ 
Do you agree to return the pet to Little Woman Home for Animals in the event that you can no longer keep it? (check one) 
Yes_____ No____
Are you willing to let a representative of Little Woman Home for Animals visit your home by appointment? (check one) 
Yes_____ No____ 
Have you ever adopted from a humane organization in the past? Yes_____ No____
If yes, name of shelter or organization:___________________________________________ 
Have you ever released an animal to any other shelter? 
Yes_____ No____
If yes, please explain:
______________________________________________________________________________________________________________

References: 
Please provide the names and phone number of two pet friendly references (neighbors, friends, etc.) Relatives may not be references. 
Reference #1: Name:___________________________________________
Relationship to applicant:____________________________ 
City:________________
State:_____________ 
Day phone number:                                                            
Evening phone number: ___        ____________________ 
E-Mail Address:_________________________________
Reference #2: 
Name:___________________________________________ 
Relationship to applicant:____________________________ 
City:____________________ 
State:____________    _____ 
Day phone number:                                                                      
Evening phone number:___________________________________ 
E-Mail Address:____________________________        ________ 
 
By signing and sending this application, I certify that the information provided on this application is true and I recognize that any misrepresentation of facts may result in losing adoption privileges. I authorize investigation of all statements in this application and understand that veterinarians, landlords, other humane organizations, references, etc. may be contacted. I further understand that the adoption of this animal may be delayed until this information can be verified. If at any time a representative for Little Woman Home for Animals and/or local authorities determines the animal is being neglected or abused, this application will be void and ownership will revert back to Little Woman Home for Animals. 

Signature:______________________________ 

Date:_________________________ 

See adoption policy which follows and
is incorporated as part of this document

Little Woman Home for Animals 
Adoption Policy 
 
Mailing Address: 
66 Evelyn Lane 
Huntsville, TX 77340
Phone:  (936) 435-9820 (936) 662-6502 
www.littlewomanhome.org

Adopter's Name:____________________________________ 
Animal's Name:_____________________________________ 

Adoption Policy 
I hereby agree to: 
1. Keep and maintain the animal in a humane manner and keep it in my home or on my property. All cats adopted must be indoor cats only. 
2. Take the animal to a licensed veterinarian within ten (10) days from the adoption date for a medical examination, to insure its health. 
3. If the pet is a cat, have the cat tested for FELV/FIV at its first veterinarian visit, if it has not already been tested. If the cat tests positive it may be returned to Little Woman Home for Animals, for special placement with a foster family. 
4. Have the animal spayed or neutered by a licensed veterinarian within 10 days of adoption or when the pet reaches the age of 4-6 months, if not spayed/neutered when adopted. In the event I do not have the animal spayed or neutered within the specified time, the ownership of the animal shall revert back to Little Woman Home for Animals. 
5. Provide any medical attention required or needed. This includes at least one annual medical check up, any vaccinations indicated and preventative medications. 6. Have the animal vaccinated against rabies as required by state law. 
7. Not give away or abandon the animal. If I find myself unable to keep it, I will return it to Little Woman Home for Animals. 
8. Hold Little Woman Home for Animals harmless from any incurred fees or damages caused by the animal while in my care. 
9. I understand a veterinarian has treated this pet, while in the care of Little Woman Home for Animals and that they have taken every step possible to provide me with a healthy animal. I do agree to hold Little Woman Home for Animals harmless, if the pet does have an illness that went undiscovered while in their care. 
10. Give permission to agents of Little Woman Home for Animals to visit my premises at any reasonable time to insure the compliance of this contract. 
Fees paid at the time of adoption include: 
1. First and possible follow up Veterinarian's examination (s). 
2. Initial vaccinations and possible follow up vaccines for cats 
3. Any medications the pet has been on up to the time of adoption. 
4. Care of the animal while at Little Woman Home for Animals. 
5. Socialization of the animal with humans and other pets. 
 
Signature:______________________________________ 

Date:_____________________________ 
 
Print Name:________________________________________