Date: pup interested in...1st choice: 2nd choice:
1 Name of applicant:
applicant's spouse/partner's name:
How long have you lived together:
2 COMPLETE address:
3 How long at this address:
4 Telephone #s:(h) (w) (c)
5 Email address:
6 With whom are you employed, your occupation and how long with current employer:
7 Spouse/partner's employer, their occupation and how long with current employer:
8(a) Number of children living in this household: list their 1st names & ages:
(b) List 1st names & ages of all adults living in this household:
Occupations of adults not listed in question #1:
(c)Is anyone living in this household either pregnant or trying to become pregnant:
9 What type of environment do you live in: Rural___Suburb___City___
10 Housing: Apt___House___Duplex___Mobile Home___Other___
11 Do you rent or own?
(a)If you rent, do you have permission from your landlord to own a companion animal under 25lbs? over 25lbs?
(b) Name and telephone# of property owner/management:
12(a) What other dogs/cats have you previously owned and what happened to them(state pet's name, age, if speutered, reason for giving up/cause & year of death):
(b) What other dogs/cats currently live in your home:(please list: names, breed, sex, age, any health issues they may have & if speutered):
13 Are there any other types of animals currently living in your home(if so, please describe):
14 What do you know about the breed in question(it is required that you research this breed's traits & habits BEFORE you apply for this dog):
15 Are there any specific habits/problems you are not willing to work with? If so, please specify:
16 Sexual preference: M___F___No preference____
17 (a) Do you have a fenced-in yard & is it connected to the house(entire yard fenced, front yard only, backyard only fenced, and is it attached to back door, etc):
(b) what is the height & dimensions of the fenced-in area(please, be specific, as this info is REQUIRED & PERTINENT to the approval of your application):
(c) Please, describe your fencing materials(3', 4' 5' or 6' chain-link, wooden stockade, vinyl rail...2, 3 or more rails...is it reinforced w/wire, if so, what kind of wire..chicken/field/hog):
(d) What type of gates(describe, as you did in above question):
(e) Can they be opened by children:
(f) If you don't have a fenced-in yard, how will the animal be exercised and allowed to eliminate:
18 Who will supervise outdoor activities:
19 Do you have(check all that apply):Pet door____Kennel run____Dog house____Stake____
Tie-out or cable-run____Crate____None____
20 Do you have a swimming pool? Is it fenced-in separately from the rest of the yard?
21 What member of the family will be taking the MAJOR responsibility for the care of this animal:
22 Does anyone in your family have allergies to ANY animal:
23 Has anyone in your household had an issue with impulse control:
24 What are your plans for this animal: (a) protection/guard:______ (b)companion:______
(c)child's pet:_____(d)pet therapy:_____(e) agility/flyball:_____ (f)obedience:______
(g)herding:______(h)ranch work______(i)other(explain):__________________________________
25 (a) Have you ever trained a dog in obedience classes?
(b) Are you planning to take your adopted pet to obedience classes?
26 Have you ever sold, given away or surrendered a pet? If so, please provide details of situation:
27 (a) How much time are you willing to give the dog to adjust to it's new environment & family members?
(b) This dog may not be housebroken. Are you willing to take the time to work with the animal?
(c) For this adoption to be approved, it is required that you promise to always keep this animal on-leash before you open your front door, or whenever exercising your best buddy outside of a secured fenced-in area...do you agree to this stipulation?
28 Will the animal live in the home? If not, where?
29 What type of shelter will be provided when the dog is outside (doghouse/patio/decking overhang, etc):
30 Where, exactly, will the animal sleep at night and be kept when there is no one at home (i.e., crated, free roam of home, laundry/kitchen area, fenced-in yard, etc):
31 (a) On the average, how long will the animal be left alone during the day:
(b) What is the activity level of your household:
_____busy-visits by friends, meetings, children, parties at home
_____noisy-TV, stereo, machinery, tools, kids playing
_____moderate-normal comings and goings
_____quiet-homebodies, few guests
32 Do you believe in dog crates? If so, for what exact purpose(s)?
33 If you had to move & your new landowner does not allow pets, what will you do with your companion animal(CA)?
34 a When you go on vacation, will your pet accompany you or who would care for it?
b List names and tele#s of day-care/boarding facilities you plan to use:
35 Under what condition(s) would you consider giving up your companion animal?
36 (a)who is the veterinarian you currently use, or have used for your previous pets:
animal hospital's name/vet's name:
address:
telephone #:
(b) what brand of heart worm prevention do you use?
(c) Does your vet recommend a yearly Lyme vaccination for your pet?
37 How will your animal travel to the vet, or other places(i.e, crated, doggie seat belt, loose in a car/van, tethered or in crate or in box in bed of truck?):
38 May we call your vet and inquire as to your previous/current pet's health care? If not, why?
39 Are you willing to allow an H4S's representative to periodically visit your home? If not, why?
40 List NAMES, tele#s & EMAIL addresses of 3 NON-RELATED personal references , whom you have known for at least 3 years, &/or whom may be familiar with your pet ownership history:
1:
2:
3:
41 Do you have a disability or special needs; this will help us to find the BEST companion for you and your needs(if your disability is not disclosed to H4S, then we reserve the right to deny this adoption at ANY time; even at the time of delivery, when you will forfeit your deposit): NO answer? Then, we must consider this application, INCOMPLETE!
42 What arrangements have you made for your pet, if you could no longer care for them(i.e., moving over seas, extended hospital stay, nursing care facility, death)?(HUMANS are never NOT guaranteed ONE more day, so plans MUST be considered for your pet's future):
NO answer? Then, we will consider this application INCOMPLETE!
43 &, finally, please tell us a little about yourself and why you feel you could provide a good home for a rescued companion animal:
Our goal in rescuing and re-homing animals is to provide them with a loving home for the rest of their life.
The adoption fee covers their medical costs associated with the animal, medical and daily care during their foster period and transport.
All animals adopted by our group MUST BE spayed/neutered prior to finalizing the placement.
Sometimes, for reasons beyond anyone's control, an adoption does not work out.
In this case, the animal must be returned to Howlin4Spirit CARes at the adopter's expense,
via Wagging Dogs Pet Transport Service at #
704-451-9954.
Adoption contributions are not refundable, for any reason.
By signing this application, I attest to the fact that I am 25 years of age or older, & that the above information provided is correct and that you understand any future medical costs are your responsibility and we have made full disclosure regarding our & our vet's knowledge of the health of the animal.
applicant's signature:
spouse/partner's signature(if married):
