Are you inquiring about
a specific dog?
Yes
No
Date:
Name:
Birthday:
Address:
City:
State:
Zip:
Home Phone:
Work Phone:
Cell Phone:
Email:
Have
you applied to adopt a rescue dog or other companion pet from another
group?
Yes
No
How many adults in the
household?
Please list their
names, ages and occupations:
(Adult 1)
(Adult 2)
(Adult 3)
(Adult 4)
How many children in
the household?
Please list their
names, ages and occupations:
(Child 1)
(Child 2)
(Child 3)
(Child 4)
If no children in the
home, do grandchildren, nieces/nephews or other kids ever visit?
Yes
No
Who will be the primary
caregiver for the new dog?
Does this person work
away from the home?
Yes
No
How many hours per day
will the dog be left alone?
How long at current
address?
Is it a house, condo,
apartment or other
(please specify) ?
Do you own or rent?
If you rent, please
provide the name and phone number of the property owner:
Do you have a securely
fenced yard?
Yes
No
If so, what type of fence
is it (wood, chain link, block wall, etc.) ?
How high is it?
Is there a doggie door
leading to the yard?
If you do not have a
fenced yard, where and how often do you plan to take your dog to potty?
Will the dog be on a
leash?
Yes
No
Under what circumstances
would you allow your dog to be off-leash?
Are there any areas of
the house where the dog will not be allowed?
Yes
No
If so, how will you keep
the dog out of them?
Will the dog be given the
run of the house when no one is at home?
Yes
No
Where will the dog sleep?
Please note that almost
all rescued dogs are crate trained before being placed in their forever
homes. Most dogs enjoy the security of their crate, although a few will
not like being confined.
Will you provide a crate
for your new dog?
Yes
No
Have you ever trained a
dog to respond to simple commands?
Yes
No
If so, how would you
describe the method you used?
How will you discipline
your new dog for undesirable behavior?
If your new dog is not
housetrained, how will you housetrain it?
Are you aware that even
housetrained dogs need a period of adjustment in a new home?
Yes
No
What will you do if the
dog has “accidents” in the house?
How many
dogs have you owned?
How long did you have
your last dog?
How long ago?
Did you have the dog
until it died?
Yes
No
If so, at what age did it
die?
If not, what happened to
it?
Was it spayed/neutered?
Yes
No
Do you currently have a
dog(s)?
Yes
No
If so, please list their
breed, age, sex and whether they are spayed/neutered:
(Dog 1)
(Dog 2)
(Dog 3)
(Dog 4)
Where have your previous
or current dogs mostly lived, indoors or outdoors?
Do you have any other
pets or farm animals?
Yes
No
If so, please list
species:
(Animal 1)
(Animal 2)
(Animal 3)
(Animal 4)
If you have a cat(s),
describe how you hope your new dog will interact with it:
Do you or anyone in the
household smoke?
(This
only matters for animals with certain health issues.)
Yes
No
How do you intend to
exercise your new dog?
Do you have what you
consider an active lifestyle or are you more the couch potato type?
Do you travel a lot?
Yes
No
When you go out of town,
what arrangements will you make for the care of your rescued dog?
If anything were to
happen to you, what do you anticipate would happen to your dog?
Why do you want a dog (or
another dog) at this time?
Why do you want this dog
in particular?
Have you ever had a
rescued dog before?
Yes
No
Why do you want a rescued
dog?
What characteristics do
you especially want in your new dog?
What characteristics do
you not
What will you do if your
new dog has some unwanted characteristics?
What is the age range of
the dog you hope to adopt?
What sex and why?
How important to you is
it that the dog already be housetrained?
Are you willing to adopt
a special needs dog (requires medication, deaf or blind, etc.)?
What will you do if your
rescued dog barks a lot?
Please provide the name
and phone number of your current or previous veterinarian:
Please provide the names
and phone numbers of two personal references, not including family
members:
(Personal Reference 1)
(Personal Reference 2)
Do you agree to have a
representative of Helping Hands Rescue visit your home
prior to adoption?
Yes
No
Do you agree to pay an
adoption fee, depending on the dog’s age, health and possible special
needs?
Yes
No
I agree to alter the
animal adopted through Helping Hands Rescue within 2 weeks if animal is
not already altered – puppy within 6 months. I understand that if I
fail to comply, the animal may be removed from my home, without refund
of adoption fee, by Helping Hands Rescue.
Exceptions:
Signature of new owner
I agree to provide
adequate food, shelter, water, medical treatment and humane treatment at
all times.
I understand that
Helping Hands Rescue reserves the right to investigate the care,
treatment and environment of adopted animals at any time, and has the
right to immediately remove any animal adopted through them, if they
feel it is in the best interest of the animal. Adoption fees will not
be refunded after a period of 2 weeks.
Adoption fees for
dogs start at $150. Additional charges may be added for expenses for
medical, boarding, etc., that we have paid for animal.
Upon adoption, HHR
relinquishes all responsibility of the adopted dog to the new adoptive
owner. HHR will not be held liable for any personal liabilities or
damage to property or financial indebtedness incurred for the care of
the adopted animal after adoption.
Applicant Signature
Date
Typing your name to this electronic form
constitutes your consent and signature.
Thank you
for completing this application and thank you for wanting to give a
forever home to one of our rescued animals!