Interesting in adopting one of our pets? There are two ways to apply.
1) Visit us on Petfinder for a list of available dogs and/or to fill out the application form.
2) Email us with a filled out application form below. Just cut and paste into the body of an email.
Please note, you must read and follow the direction closely. All incomplete applications will cause delays. Upon receipt, we will review your application, check all your references and get back with you as soon as possible. If approved, we will schedule a convenient time for a home visit to complete the adoption process. It is necessary that we find the right home for every rescued companion animal in our program.The completed questionaire will help us to determine the very best companion for you with regards to temperament and energy level of the animal that will best suit your family, your lifestyle and habits and your home environment.
********ADOPTION APPLICATION********
Date:
Pet interested in:
Name of applicant:
Spouse’s name:
Spouse’s name:
Address:
City, State, & zip:
How long at this address:
City, State, & zip:
How long at this address:
Telephone:
(h)
(w)
(c)
Email address:
(w)
(c)
Email address:
Employer and occupation:
Spouse’s employer and occupation:
What type of environment do you live in: Rural____Suburb____City____
What type of housing do you live in: Apt___House___Duplex___Condo____Other____(please describe)
Do you own or rent:
If you rent, do you have permission from your landlord to own a companion animal and if so, is there a weight limit:
Name and telephone number(s) of landlord:
What member of the family will be taking the MAJOR responsibility for the care of this animal:
What type of housing do you live in: Apt___House___Duplex___Condo____Other____(please describe)
Do you own or rent:
If you rent, do you have permission from your landlord to own a companion animal and if so, is there a weight limit:
Name and telephone number(s) of landlord:
What member of the family will be taking the MAJOR responsibility for the care of this animal:
How many adults are living in this household (List their names, ages and occupations):
How many children living in this household (List their names & ages):
How many children living in this household (List their names & ages):
Is anyone living in this household either pregnant or trying to become pregnant?
Will grandchildren or children of relatives frequently visit the home:
Do you own currently or have you previously owned any other animals (List their breed, sex, age and if spayed/neutered):
Do you own currently or have you previously owned any other animals (List their breed, sex, age and if spayed/neutered):
If you previously owned an animal, what happened to them (List their breed, sex, age, if spayed/neutered and reason for no longer having the animal):
What do you know about the breed of animal you are currently seeking to adopt:
Are there any specific habits/problems that you are not willing to work with:
Do you have any preferences to the sex of the animal:
Do you have any preferences to the sex of the animal:
How did you hear about our rescue/who referred you to us:
Do you have a fenced-in yard? If so, is it connected to any door leading from the home (i.e. - front, back, back and side yards, etc.):
How big is the fenced-in yard (length and width):
What is the height of fence:
What is the height of fence:
What material is your fence made of (i.e. - chain link, wooden stockade, split rail reinforced with wire, field fencing, hog wire, vinyl picket, etc.):
Are there any gates? If so, what type (i.e. – chain link, wooden stockade, etc.) and can they be opened by children:
If you don't have a fenced-in yard, how do you plan to exercise or let the animal go to the bathroom?
Who will supervise outdoor activities:
Do you use any chemicals on your lawn? If so, what brand?
Do you have a swimming pool: If so, is it fenced-in separately from the rest of the yard:
Do you have(check all that apply):
Pet door
Kennel run
Dog house
Stake
Tie-out/cable run
Crate
Does anyone in your family have allergies to ANY animal:
Has anyone in the household ever had a problem with violence, or impulse control? If so, please explain:
What are your plans for this animal (check all that apply):
Has anyone in the household ever had a problem with violence, or impulse control? If so, please explain:
What are your plans for this animal (check all that apply):
Protection/guard:
Companion:
Companion:
Child's pet:
Pet therapy:
Agility/flyball:
Agility/flyball:
Obedience:
Herding:
Ranchwork:
Other(please explain):
Have you ever trained a dog in obedience classes:
Have you ever trained a dog in obedience classes:
Will you take your adopted dog to an obedience class:
Have you ever sold, given away or surrendered a pet? If so, please, provide details of the situation:
Under what conditions would you consider giving up your animal:
Under what conditions would you consider giving up your animal:
How much time are you willing to give this animal to adjust to its new environment and family members:
This dog may not be housebroken. Are you willing to take the time to work with the animal:
Will the animal live in the home: If not, where?
What shelter will be provided outside (i.e. - dog house, patio/deck with overhang, garage, etc):
Where will the animal sleep at night:
Will the animal live in the home: If not, where?
What shelter will be provided outside (i.e. - dog house, patio/deck with overhang, garage, etc):
Where will the animal sleep at night:
Where will the animal be kept when no one is (i.e. - crated, free roam of house, garage, bath/laundry/kitchen area, fenced-in yard, etc.):
On average, how long will the animal be left alone during the day:
What is the activity level of your household (check all that apply):
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:
Do you believe in dog crates? If so, for what exact purpose(s)?
If you had to move & the property owner did not allow pets, what will you do with your pet:
When you go on holiday, would you take it with you or who will care for it:
How will your animal travel to the vet, or other places(doggie seat-belt, crated, loose, tethered in car or van, loose or in box in back of truck?):
Who is the veterinarian you currently use:(or have used in the past 5 years-please, provide ALL info):
Name:
Address:
Telephone:
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:
Do you believe in dog crates? If so, for what exact purpose(s)?
If you had to move & the property owner did not allow pets, what will you do with your pet:
When you go on holiday, would you take it with you or who will care for it:
How will your animal travel to the vet, or other places(doggie seat-belt, crated, loose, tethered in car or van, loose or in box in back of truck?):
Who is the veterinarian you currently use:(or have used in the past 5 years-please, provide ALL info):
Name:
Address:
Telephone:
What type of heartworm prevention do you/have you used?
What type of flea/tick prevention have you used?
May we call your vet regarding your previous/current pet's healthcare (Please be sure to contact your vet & tell them to release all info to H4S for our consideration, as soon as you send in your application): If not, why?
Are you willing to allow an NDR's rep to visit your home: If not, why:
List names and email addresses of 3 personal references (NOT related to you), whom you have known for at least 5 years:
1:
2:
3.
Are you willing to allow an NDR's rep to visit your home: If not, why:
List names and email addresses of 3 personal references (NOT related to you), whom you have known for at least 5 years:
1:
2:
3.
If you are disabled and should have any special needs, please specify to help us find the BEST companion for you and your needs:
What arrangements have you made in case you can no longer care for your animal?
Tell us a little about yourself and why you feel you could provide a good home for an animal:
Our goal in rescuing animals is to provide them with a safe, loving home for the rest of their life. The adoption fee covers costs associated with the animal’s medical and daily care during their foster period and transport. Adoption contributions are non-refundable.
Your signature below states that you understand any future medical costs are your responsibility and we have made full disclosure regarding our and our vet's knowledge of the health of our animals.
By signing this application, you attest to the fact that you are 21 years of age or older, and that the above information provided is correct:
What arrangements have you made in case you can no longer care for your animal?
Tell us a little about yourself and why you feel you could provide a good home for an animal:
Our goal in rescuing animals is to provide them with a safe, loving home for the rest of their life. The adoption fee covers costs associated with the animal’s medical and daily care during their foster period and transport. Adoption contributions are non-refundable.
Your signature below states that you understand any future medical costs are your responsibility and we have made full disclosure regarding our and our vet's knowledge of the health of our animals.
By signing this application, you attest to the fact that you are 21 years of age or older, and that the above information provided is correct:
Your signature:
spouse’s signature:
