Name(s) of Dogs or Cat You Wish To Adopt: Include
/Breed(s)/Age(s): |
|
| Applicant's Name: |
|
| Applicant's Age |
|
|
Person Filling Out Application (if not the same as
the actual applicant) Please be factual.
|
|
| Telephone: Home |
|
| Telephone: Work |
|
| Telephone: Cell |
|
| Email Address: |
|
| Home Address: |
|
| City: |
|
| State: |
|
| Zip: |
|
| Do you live in a: |
|
| Do you rent or own? |
|
|
| If you do NOT rent your home, are you the owner of the
home? Who owns the home? |
|
|
| Landlord Name: |
|
| Landlord Phone |
|
| Applicant Employer: |
|
| Does anyone in your home have allergies to animals? |
YES NO No
Response |
| Does anyone have asthma? |
Yes No No
Response |
| What size is your yard |
(Sq. Ft) |
| Is your yard totally fenced in ? |
Yes
No No Response |
| Type of fence: |
|
| Height: |
|
Please describe your fence
|
|
| Please provide SPECIFIC information for the following
questions about where the dog will be kept. Tell us WHERE --
If outside, where outside? If inside, where inside? Please
describe in as much detail as possible about each area , and
provide anything else that will help us understand exactly where the
animal will be kept. Failure to provide this level of detail
will result in a delay in the application being
processed. |
| Where will the pet be kept during the day? Please
provide detail -- if in the house, where in the house? If
outside, where outside? |
|
| During the night? Please provide detail -- if in the
house, where in the house? If outside, where outside? |
|
| During routine absences such as trips to the grocery
store? Please provide detail -- if in the house, where in the
house? If outside, where outside? |
|
| Do you have (check all those that apply): |
Pet
Door
Kennel Run
Dog House
Tie-out Stake
Crate |
| If you have any of the above, how are they used, how
often are they used and under what circumstances? |
|
|
| How many adults live in your home?
How many children live in your home? |
|
| Ages of children? |
|
| If you do not have children yourself, are there children who
visit your house regularly (Defined as once a
month)? Describe the situation in as much detail as
possible: Are they relatives? Are these children
supervised? Please provide details. Failure to respond in
detail will delay your application. |
|
|
| I have read the description of the dog carefully and believe
that my household is in compliance with the limitations placed
on the dog's placement. (For example, if the description says
"no cats," the household should not have cats.) |
|
|
| Are you, your spouse or partner, housemate or anyone residing
with you currently pregnant? What is their relationship to
the applicant and when is the child due? Will they be living
with the applicant following the birth of the child? |
|
|
| Is anyone home during the day? |
Yes No No Response |
| If someone is at home, how long? |
Hours |
| Who will be at home during the day? Please
provide detail. |
|
| Can they handle the animal you want to adopt? |
Yes No No
Response |
| All members of the household, including
pets, must visit with the animal before the adoption is
approved. |
| How many hours at one stretch will the pet be without
humans each day? |
Hours |
| How many hours TOTAL will the pet be without humans
each day? |
Hours |
| Who will be the primary care-giver? |
|
| What is the primary care-giver's relationship to you? |
|
|
| Who will care for the animal while you are on
vacation? |
|
| What will you do with the animal if you move? |
|
| Are you willing and able to provide pet
care for the next ten (10) or more years, including vet checks,
vaccinations, boarding, medical care, food, treats, etc.? Yes No No Response |
| What do you think pet care costs per year,
including annual vaccinations, food, toys, minimal boarding,
grooming,
etc.?
$ |
| Are you willing and able to support a pet? |
Yes
No No Response |
| We require all animals adopted from us to be
spayed or neutered. Do you have any questions or reservations
about this policy? Yes No No Response |
| Please list all pets you have owned in the
past 10 years. If none, then include pets owned in your
childhood. PLEASE LIST ANY ANIMALS
RESIDING WITH YOU, EVEN IF YOU DO NOT OWN THEM . |
| Pet 1
Pet's Name
Breed Gender Age
Spay/Neut (Yes/No)
How Long Owned Years
What happened to the pet?
If deceased, how old was the pet when the pet died & explain
details of death:
If
deceased, in what year did the pet die?
|
| Pet 2
Pet's Name
Breed Gender Age
Spay/Neut (Yes/No)
How Long Owned Years
What happened to to the pet?
If deceased, how old was the pet when the pet died & explain
details of death:
If pet
is deceased, in what year did the pet die?
|
| Pet 3
Pet's Name
Breed Gender Age
Spay/Neut (Yes/No)
How Long Owned Years
What happened to it?
If deceased, how old was the pet when the pet died & explain
details of death:
If pet
is deceased, in what year did the pet die?
|
| Pet 4
Pet's Name
Breed Gender Age
Spay/Neut (Yes/No)
How Long Owned Years
What happened to the pet?
If deceased, how old was the pet when the pet died & explain
details of death:
If pet
is deceased, in what year did the pet die?
|
If you have additional pets, please list their names
and ages here, and provide additional information as
possible.
|
|
| If you have ever had a pet lost, disappear or die at
an early age, please provide details (dogs dying before 10 or cats
before 14 years of age): |
|
| Have you ever sold, given away or surrendered a pet?
Please provide details above. Have you ever had to
re-home a pet? |
Yes No No
Response |
| How do you plan to exercise your dog? (Provide
details.) |
|
| Who will supervise outdoor activities? |
|
|
| How will dog be confined outside during exercise? |
|
|
| Have you ever trained a dog? |
|
|
| Have you ever crate trained a dog? |
|
|
| How do you plan to train the dog? |
|
|
| Are you willing to give this dog time to adjust to its new
environment and family members? |
|
|
| How much time are you willing to give the dog to adjust to its
new environment and family members? |
|
|
| This animal may not be housebroken. Are you willing to
take the time to work with the animal? |
|
|
|
Some vets will not release vet records
without permission from the applicant. To speed the process,
please contact your vet to let them know
that we will be calling. Also, please let us know if the records are under a different last name.
|
|
I will alert my vet that HH will be calling.
|
YES NO
|
|
| Past/current vet PLEASE INCLUDE SEVERAL YEARS' WORTH OF VET
INFORMATION, AND THE VET INFORMATION FOR ALL PETS. |
|
|
| Past/current vet's phone number PLEASE PROVIDE THIS
INFORMATION AT THE TIME OF APPLICATION. |
|
|
| Pets treated |
|
|
| Intended vet |
|
|
| Are there any existing circumstances (e.g., health, family,
professional, financial) that could result in your being unable to
take care of this dog? What are they? |
|
|
| Why did you choose this dog? |
|
|
Are you currently working with other rescues to find
a dog? Which groups? If so, where are you in the
adoption process with these groups? NOTE: Working with
other groups is not a mark against you -- we ask this so we
can see if you have already been approved with another group or so
we can work with them to let them know that you have been approved
with us.
|
|
|
|
PLEASE TAKE A MOMENT TO LET US KNOW WHERE YOU
HEARD ABOUT US BY ANSWERING THE QUESTION IMMEDIATELY BELOW.
THIS HELPS US TO ALLOCATE OUR MARKETING TIME
APPROPRIATELY.
|
|
| How did you hear about us/Who referred you? (Check as many as
apply and fill out the blank if you need to add additional info.) |
Petfinder
Friday's Dog
Friend/Coworker Other Rescue Crate
Former adopter
Other
|
|
| We require a home visit as part of the application
process. Will you comply? |
|
|
| We require that all family members, including animals, meet the
animal prior to placement. Will you comply? |
|
|
Has everyone in the family been alerted to the
decision to get the pet? Has every adult been alerted
?
|
|
|
| We require a non-tax-deductible adoption fee of $250 at the time of
placement. This money goes to fund medical care, food and
shelter for all of our animals, not merely the one you are applying
for. Will you comply? |
|
|
If you are approved for this dog, how soon would you
be able to take him or her?
|
|
|
| Is there anything else we should know that would help us to
understand your application? |
|
|
| A rescue representative will conduct a
formal interview with you and your family prior to adoption.
This interview is to answer any questions about your new pet and to
alert you to problems that may arise. The rep will help you
plan how to successfully introduce your new pet to your new home and
to explain how to help your new pet become part of the family.
Please make sure that you have answered all questions in this
application. Failure to provide information necessary to
complete this application may cause this application to be
voided.
I certify that I have answered all questions honestly and to
the best of my ability. I understand that any
misrepresentations of fact may result in removal of the adopted pet
from my home. |
| Applicant's Signature: |
|
| Date: |
|
|
|