Happy Dog Rescue Adoption Application

Use the TAB key to move from field to field. If you hit the enter key, the app will submit before you have completed it.
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Adoption Fee: $250 + tax

You must be 21 or older and not living with your parents to submit an application. If you're under 21 or still live with your parents, please have your parents submit the app.

We realize this application is lengthy, but it really does help us evaluate whether or not the dog you are applying for is a good match for your family/lifestyle. You are not applying to a shelter, but rather a private foster home. We handle less dogs than shelters and have more time to evaluate the matches between adopter and dog, resulting in far fewer returns than a shelter situation. The more detail you can provide, the more help we can give you in selecting a dog you will enjoy for the rest of it's life. If you do not wish to answer all of the questions on this application, please do not submit it. In order to have the time to give personal attention to the adopters willing to work with us through this process, we do not process or respond to incomplete applications.

Applicant's Name:
Email Address:

Co-Applicant's Name:
Home Address: City: ST: Zip:
Home Phone: Cell Phone: Best time to call:

Names and ages of all permanent residents in your home (adults/children):
Are you planning to change residence in the near future? No    Yes, explain:

Have you contacted/applied to any other rescues or shelters about a specific dog? Yes No
Are you going to meet another dog? Yes No If so, when?

What county do you live in? (Click arrow to view counties.) Other Northampton PA Lehigh PA Warren NJ Hunterdon NJ Carbon PA Monroe PA Upper Bucks PA Other:
Name of the dog you are interested in adopting:
Is anyone in your home allergic to dogs? No Yes
Does anyone in your household fear dogs? No Yes - If so, please explain:
Does anyone in your household smoke? No Yes - If yes, where in your home do you smoke?

Are you familiar with dog regulations in your area? No    Yes
If you answered no to the question above, please contact your town/county/condo assoc and ask them what the regulations are.
If you answered yes, please describe:

Do you rent or own?     What do you live in? House Apartment
Condo/Townhome - Any size limit on dogs there? Trailer
If you rent, you must show us a written letter from your landlord or a copy of your lease stating that you are allowed to have dogs.
If you live in a condo or townhome, you must show us written proof that you are allowed to have a dog there.

Approximate square footage of your home:
Do you have a yard? Yard, fenced / Fence height:      Yard, not fenced     No yard
Approximately how wide is your yard?
Approximately how deep is your yard?
What are your exercise plans for this dog?

Annual Household Income (click arrow to view choices): Click arrow to choose $0-$20,000 $20,001-$30,000 $30,001-$40,000 $40,001-$50,000 $50,001-$75,000 $75,001 or higher

Do you work outside the home? No Yes, how many hours per week?
How many hours will this dog be left alone during a typical day? (Explain)

Have you discussed dog adoption with all members of your family? Yes No - who in your family does not know about this?
Is the dog for which you are applying going to be a gift? No Yes - for who? (Name/relationship to you):
If this dog will be a gift, does the recipient know they are getting a dog? Yes No
Is everyone in your household in agreement on adopting a dog? Yes No

What would your dream dog be like?
.

Have you had dogs in the past? Yes  No
Do you plan to obedience train your new dog? No Yes
Are you willing to housebreak a dog? No Yes

How much do you feel you can reasonably afford and would be willing to spend on your dog per year (for things like veterinary care, licensing, ID tag, food, toys, crate, other supplies, training, pet sitting, etc)?

Check all that apply to your situation. I want to adopt this dog: as a family pet to use for breeding
to train/use for hunting to train/use for agility competitions to train/use as a therapy dog
to train/use as an assistance dog for the disabled to use as a jogging partner to train/use as a search & rescue dog
to train/use as a guard dog to interact with lots of friends/family
to border train it to our yard. Describe the method you plan to use for border training
Other:

My adopted dog will (check all that apply):
be kept outside: number of hours per day: be kept indoors most of the time
be left outside when we are away at work have access to a doggie door leading to a securely fenced area - how big?
be kept in the basement be kept on the main floor of our home most of the time
have free reign of the house most of the time be crated when we are not home
take frequent car rides with us frequently be kept outdoors in a kennel run
rarely travel in a vehicle with us be kept on a lead line/cable in the yard
be frequently interacting with multiple children be mostly interacting with adults

Please check any items below that you are NOT willing to deal with in your adopted dog (Check boxes below to indicate items you DO NOT want to deal with at the time of adoption or any time during the life of the dog):

Housebreaking Chewing Obedience training (Sit/Down/Stay/Heal/Come) Leash training
Fear of men Fear of women Fear of children Fear of other dogs Fear of loud noises Submissive peeing
Food/Toy Aggression Separation Anxiety Counter Surfing (stealing food off counters) Frequent barking
Blindness Limited sight Deafness Hearing impairment Diabetes Special Diet Long-Term Medications
Surgery Physical Therapy Incontinence (leaking urine, usually due to old age)

What would cause you to return a dog to Happy Dog Rescue?
.

Will you assume all financial responsibilities for the dog you adopt including inoculations as recommended by your vet, regular veterinary care (yearly examination, yearly heartworm/lymes test, yearly fecal), good quality food, licensing, ID tag, dog bed, leash, collar, toys, etc.? Yes No

Describe how to groom a dog.
.

Briefly describe how to obedience train a dog
.

Do you plan to take formal obedience classes with your new dog? Yes No (if no, why not?)

Descibe how this dog will be cared for/spend it's time when you are away during the day, in the evening, and on vacation.
.

Where will you keep this dog? (check all that apply)
Crated while I'm at work (indicate # of hours):
Free reign of the house    Main floor of house
Basement of house. Describe your basement:
Backyard Outdoor kennel run, dimensions:
Other, explain/describe:

How long have you been looking for a dog?
Where have you looked? Newspaper  Breeder Local shelter Pet Store Vet's Office Petfinder.com

If you don't currently have a vet, list a former vet or the vet you plan to use if you adopt.
Current Veterinarian:
Veterinarian's Address: City: ST: Zip:
Veterinarian's Phone: Veterinarian's Fax:

Do you have any pet(s) currently? List their names, type (dog/cat, etc), breed, age, sex and approximate weight, and length of time you have had them. .

Have you had dogs in the past? Yes    No
How many years did you have the dog(s)? Reason(s) for no longer having the dog(s)?
What were the circumstances of your last dog's death?
Has any dog of yours ever gotten lost, been poisoned, or been killed by a vehicle? No    Yes, explain:
Would you allow a dog to ride loose in the bed of a truck? No   Yes
Have your current pet(s) been around dogs in the past? No   Yes
Are your current pets altered (spayed/neutered)? Yes No - Explanation:

Additional comments, questions or concerns:

Applicant Agreement

Please read before signing!

If you have any current pets, please contact your vet and advise them that Happy Dog Rescue will be calling for a vet reference. We will need to know if your current pet(s) are altered and up to date on their vaccinations. We will also need to know how frequently you take your animals in to the vet for an examination. Veterinarians will not release this information without your permission. Please email us after you have made this call so that we know your vet will release the information to us. Your vet may require written permission from you prior to releasing this information.

By signing below, you are giving permission for Happy Dog Rescue to use the information on this application to contact your references and veterinarian and you give permission for your veterinarian to release your pets' medical records to our rescue.

By signing below, you certify that you have read, understood, agree with, and will comply with, the Happy Dog Rescue adoption policies. You further certify that the information you have provided on this form is true, correct, and complete. You understand and agree that falsification of any of the above information or any information disclosed during the review process is grounds to disqualify your adoption application and nullify all adoption(s) and/or adoption agreements between you and Happy Dog Rescue. By checking the box below, you certify that this is your electronic signature guaranteeing that everything you say on this application is true. You further agree that your electronic signature is binding on this adoption application. Please check the box below and fill in your name(s) to indicate that you have read, understand, and agree to all of the above.

Applicant's Signature (type your name): Date:
Co-Applicant's Signature (type your name): Date: