Application for Adoption Application For Dog / Puppy
(there is a $10 application fee)
I am applying for the dog named __________________
Date _____________
In order for HHS to best match our rescued pets to your family, please fill out the following questionnaire. Incomplete applications will NOT be considered.
There is a 10.00 Non-Refundable application fee that has to be sent in with the application to help cover our expenses.
Please answer all questions completely. We are not trying to be intrusive. We are volunteers doing everything we possibly can to find the best match for each pet and each family. Thank you for understanding.
Name __________________________________________________________
Address _______________________________________________________
City _________________________ State ______ Zip _________
Home number ______________________ Cell ___________________
Fax __________________ E-mail_______________________________
Occupation: ____________________________
Employer __________________________
Martial status: ____________ Partner's name _______________ Your age________
Please describe your average workday
How did you hear about us? _____________________________________________
Type of dog desired? ___________________________________
Is this a gift for someone? ___________________________________
Have you ever owned a dog(s) before? __________
Where is that dog(s) now? ___________________________________
Why have you chosen to adopt a rescue?
Does everyone in your family want this dog? ____________________
How many adults are in your household? _______________
Are there children in the household? _________________
What are their ages? _________________________________________________
What other pets are in the household?
Are they spayed/neutered? _______________________________
If not, Why not and do you plan to do so?
How many hours a day will your pet be left alone? ___________
What type of home are you in? ___________________________________
Do you rent, or do you own your own home? _________________
If you rent are you allowed to have pets? ____________
Are there any pet restrictions? ________________________
What is the name and phone number to your landlord?
How long have you lived at this residence? ___________________
Do you plan to move in the near future? __________________
What if you had to move and the place you choose didn't allow pets?
What will you do with your pets if your life circumstances change, i.e., divorce, separation, death in the family, etc.?
Are you acquainted with a nearby veterinarian? _________________
Veterinarian's name and phone number:
A Reference name and phone number: Some one that has known you for at least 3 yrs and NOT a Relative. Best time to call them?
Do we have your permission to contact your landlord, veterinarian and reference? ____________
Do you have a fenced yard? ____________________
Please describe the enclosure
Are you willing to install a fence or dog run? _________________________
How long will your dog left alone outside? _____________________
Where will your dog be kept during the day? ____________________________
Where will your dog be kept at night? ___________________________
What accommodations will you make for your dog if you're away overnight or away on vacation?
Who will be responsible for your dog's upkeep? ______________________
How will you exercise your dog?
Are you prepared to make a lifetime commitment to this dog? ______________
Are you prepared to devote extra time and/or training in the beginning? ___________
Until your dog learns the rules of your home, he may urinate or defecate in your home, and may chew household items. How will you handle this?
Please describe how you will discipline your dog
How will you prevent fleas and ticks?
How will you prevent Heartworms?
I would give up my pet if
Please add any comments that may help me make a decision.
Do you have any objection to a volunteer visiting your home? ______________
Thank you for taking the time to answer these questions, all applications will be reviewed and approved by the board and reference check before the dog will be permanently placed.
The adoption donation of
$100.00 - $400.00
includes items marked with an
X
:
X
Vet checkup,
X
Fecal exam, Blood work for Heartworm, Ehrlichia, Lyme test, Spayed or Neuter, Rabies Vaccine,
X
Distemper, Adeno Virus 2, Parainfluenza, ParvoVirus, Corona Virus Vaccines, Leptospirosis Vaccine (if old enough), Bordetella Vaccine, Frontline (de-flea/tick), & Microchip (life time implant identification system), Initial grooming (if necessary),
X
Ear mite treatment (if necessary),
X
De-worming
All rescued pets are adopted with the above complete according to the age and health of the dog/puppy. We do the best we can to ensure the puppy or dogs health. These are rescued pets and we usually know very little about their past. Other procedures are sometimes performed such as tumor removal, bone repair, extensive blood work, X-rays, medical treatment for illnesses or dental work, which will be documented and completed before the adoption.
Once the puppy or dog is placed in your home you will be responsible for any additional necessary medical expenses. Adoptions are as-is and we will not be held responsible for any vet bills that you may incur after the dog is placed in your home. If for any reason you are not happy with your rescued canine companion, you may return the dog/puppy to us.
I attest that all answers to the above questions are true to the best of my knowledge. I have read and understand this document, if I am approved to adopt from HHS. I agree to the above.
Applicant Signature___________________________________________
Date: _______________________________
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