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Dog Adoption Application
First Name (*)
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Last Name (*)
*required
Spouse/Partner Name
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Street Address (*)
*required
City (*)
*required
State (*)
*required
Zip Code (*)
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Email (*)
*required
Please retype your email (*)
*required
Home Phone (*)
*required
Cell Phone
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Drivers License Number (*)
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Driver's license expiration date (*)
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Your Occupation (*)
*required
Place of Employment (*)
*required
Office Phone (*)
*required
Spouse/Partner's Occupation
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Spouse/Partner's Place of Employment
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Which dog are you interested in?
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How many adults in your household? (*)
*required
How many children? (*)
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Children(s) age(s)
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Are all members of the household willing to be responsible for a new pet? (*)
Yes
No
*required
Would you say your level of physical activity as a family is: (*)
Limited (less than 4 hours of physical exercise a week)
Moderate (4-8 hours of physical exercise a week)
High (over 8 hours of physical exercise a week)
*required
Does anyone in your house have allergies? (*)
*required
You live in: (*)
a house you OWN
a condo/townhome you OWN
a mobile home you OWN
an apartment your RENT
a house you RENT
a mobile home you RENT
*required
If you rent, please supply us with your landlord's contact name and phone number.
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Do you have a pet fee you must pay your land lord or HOA? How much is it? (*)
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Is there a fenced yard? (*)
Yes
No
*required
What type of fencing?
No fencing
Privacy fence
Chain link
Picket
Invisible
Other
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How high is the fence?
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How long have you lived at this address? (*)
*required
Are you moving in the forseable future? (*)
No
Yes
*required
If yes, what will happen to the dog?
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Do you know about heartworm disease? (*)
Yes
No
Not Sure
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Pet 1 Type
None
Cat
Dog
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Pet 1 Age
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Pet 1 Sex
Female
Male
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Spayed/Neutered?
Yes
No
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Pet 1 current on (select all that apply)
rabies vaccination
other age appropriate vaccinations
heartworm prevention
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What happend to the pet if no longer with you?
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Pet 2 Type
None
Cat
Dog
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Pet 2 Age
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Pet 2 Sex
Female
Male
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Spayed/Neutered?
Yes
No
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Pet 2 current on (select all that apply)
rabies vaccination
other age appropriate vaccinations
heartworm prevention
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What happend to the pet if no longer with you?
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Pet 3 Type
None
Cat
Dog
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Pet 3 Age
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Pet 3 Sex
Female
Male
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Spayed/Neutered?
Yes
No
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Pet 3 current on (select all that apply)
rabies vaccination
other age appropriate vaccinations
heartworm prevention
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What happend to the pet if no longer with you?
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What other pets do you have?
Reptile(s)
Bird(s)
Livestock
Ferret(s)
Pocket pets (mice, hamsters, rats, etc.)
Other
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Current/most recent veterinarian/clinic
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Current/most recent veterinarian/clinic phone
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If you do not currently have a vet, where do you plan to take your new pet?
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Reference #1 (*)
Name Number Relationship to you
*required
Reference #2 (*)
Name Number Relationship to you
*required
Reference #3 (*)
Name Number Relationship to you
*required
Reason(s) for wanting this pet - please check all that apply: (*)
Companion for self
Companion for children
Companion for other pet
Gift
Protection
Pest control
Hunting
*required
Is someone home during the day or will someone be able to come home during the day to exercise the dog? (*)
Yes
No
*required
Details
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Where/how will the dog be confined on your property during the day: (*)
*required
Where/how will the dog be confined on your property during the night: (*)
*required
Other information that may be relevant with regards to confinement of the dog (doggy day care, etc.):
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What arrangements will you make for your pet when you travel or are on vacation? (*)
*required
Have you used a crate before?
Yes
No
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What books have you read pertaining to this breed, or the care and training of dogs in general?
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What will you do if the dog develops behavior problems after adoption? (*)
*required
Is there anything else you would like to add?
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How did you hear about us? (This will help our marketing so please answer.)
Google search
Yahoo search
Bing/MSN search
Petfinder/other pet listing service
Flyer or business card
Forwarded email
Friend/family referral
Other rescue group
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If you had a referral from a friend or a group, please let us know who it was:
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"I certify that the above information is true and correct to the best of my knowledge. I authorize investigation of all statements in this application and understand that veterinarians, humane societies, landlords, etc. may be contacted. I also understand that BHVFR reserves the right to deny the adoption if I am proven unsuitable, based upon this application and investigations of this information, and that BHVFR reserves the right to not disclose the reason for denial."
Type your initials in the box to confirm your understanding. (*)
*required
Please let us know you're not a bot.
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