| Homeless Pets Foundation |
Office use only |
| Dog Application |
PET NAME
DATE HP REP ADOPTION FEE CSH CHK CC |
Name
Co-Applicant
Phone
Address
City
State
Zip
Please indicate where you live:
o apartment o house
o condo/townhouse
o trailer/mobile home
How long have you lived at this address?
How many times have you moved in the last 5 years?
Do you o Own o Rent Does your landlord/lease allow pets?
o No o Yes Weight limit
Is there a limit to the number of pets allowed?
o No o Yes
How many?
Name of apt complex phone
Amount of pet deposit?
Are you willing to allow a representative from The Homeless Pets Foundation to
visit your home by appointment?
o Yes o No Why?
Are You o Working o Retired
o Attending School
o Homemaker o Other
Employer's Name Work Phone
Occupation_________________________________________________________________________________
Address
City
State
Zip
Working Hours
E-mail Address
Please
check any of the following reason for adopting this dog: o
Family Pet o
Child’s Pet o
Watchdog
o Companion o
Hunting dog o
Guard dog for business o
companion for other pet o
gift
o
other, please specify
Will anyone in your household be surprised by the adoption of this
pet?
o No o Yes, who
Are there any other adults living in the household?
o No o Yes If yes, please
list below
1. Name
Relation
Age
2. Name
Relation
Age
Are any family members of your household allergic to this pet?
o No o Yes, What steps will you take
to accommodate the pet(s) and the household member?
Do you or any member of your household have a serious or life threatening
illness? o No o Yes,
Please explain
How many children at home?
Please list ages
How will you handle interaction between your pet and your children?
| Type of pet | De-clawed? | Age | Name |
| 1. | |||
| 2. | |||
| 3. | |||
| 4. |
| Type of pet | Age | Altered? | How long? | Describe What happened |
| 1. | ||||
| 2. | ||||
| 3. | ||||
| 4. | ||||
| 5. |
Veterinarian's Name
Phone
Address
City
State
Zip
How much do you expect to spend annually on vet care for your pet?
Do your current pets or did your past pets receive
monthly heartworm and flea preventative?
o Yes o No Why?
If yes, what brands do/did you use?
How often did you give it?
Max hours pet will be left alone on a typical day?
Who will be responsible for daily care and training of your new dog?
o Self o Spouse
o Children o Roommate
Where will new dog be kept primarily?
Is your yard fenced in? o No
o Yes What kind of fence?
Height
Do you ever let your dog off leash in an un-fenced area?
Explain
Where will new dog stay when you are not at home?
o outside in fenced area o outside in dog
pen
o outside on chain or tie-out
o inside in basement o in the garage
o inside free run of house
o inside in crate o
inside in one room of house room?
o Other
Where will new dog sleep at night? o Dog
house in fenced in yard o
dog house in dog pen
o dog house near tie-out
o inside in basement o In the garage
o inside free run of house
o inside in crate
o in my bed o other
Have you ever had a serious behavior problem with a previous dog?
o No o Yes, Please explain
What methods will you use for house training? o Crate
training o Newspaper
o Rubbing nose
o Swatting w/
newspaper o Outside only
o Other Please explain
What circumstances, in your mind, justify giving up a dog?
o Aggression o Medical
Problems
o Ruining furniture
o Not house broken o Moving
o Divorce o New
Baby o Shedding
o Allergies
o Children Lost Interest o Getting
Loose o Barking
o Not getting along with other pets
o Lost job
o Married o Medical problems
o Not getting along w/ child o Got too big
o Too time consuming
o Other
Would you try to fix problem? o
No o Yes How
Have you ever given up a pet? o No o Yes Why
If you date or marry someone who does not like or want pets, what will you do?
o Find another home for him/her
o Have him/her put to sleep
o Give him/her to rescue group or
shelter o Other, please explain
If your dog develops an expensive medical problem what would you do?
o Have him put to sleep since he is older
o Give him to rescue group or shelter
o Other, please explain
Can you provide a permanent loving home for this dog for 10-15 years?
Are you willing to keep a collar and ID tag on all of your pets including a new
dog at all times? o Yes o No, Why not?
Have you ever looked at or applied for a pet with another rescue group? o No o Yes, please list
| Reference Name | Address | City | State | Zip | Phone |
| 1. | |||||
| 2. |
By signing below, I am
attesting to the truthfulness of my answers. Falsification of any of the above
information will be grounds for disallowing the adoption of the rescue dog and
possible removal of said dog from my home. I consent to Homeless Pets
Foundation representatives discussing information on this application with any
persons named on this application. Applicant muse be 21 yeast of age or older.
Homeless Pets Foundation reserves the right to refuse any applicant for any
reason. All completed applications become the property of Homeless Pets
Foundation.
Signature of Adopter Date
For Homeless Pets Use Only
| D.L. Number | State | Exp | Phone Check | Vet Check | Home Visit |
Pet Adopted? o No o Yes Name of dog:
Fee Paid $
o Cash o Check o Charge
Exp
Added donation? o No o Yes $