Dog Adoption Application Name* First Last Email address* Date of Birth* Date Format: MM slash DD slash YYYY Home Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How long have you been at this address?*Employer*How long have you been with this company?*Daytime Phone*Evening Phone*Best time to call* : HH MM AM PM If adults are in the home, list their relation to applicant. If children are in the home, list ages below: Do you own or rent?*OwnRentPlease provide landlords name and numberBy providing this information, you are giving permission for HHR to call and speak with your landlordPlease describe your household*ActiveCalmQuietAverageDo you have a fenced-in yard?*If so, please describe said fence (dimensions, material, height, gate, etc) if you do not have a fence, please describe how the dog will be outside.Do you own a vehicle?*YesNoDriver's License Number*Where/how will animal ride in vehicle?*Does anyone in the home have a known allergy to dogs?*YesNoIs everyone in the home in agreement with the decision to adopt a dog?*YesNoWhat other pets live at the residence?NameBreedAge Are these pets up to date on vaccinations?*YesNoAre these pets current on heartworm prevention?*YesNoAre these pets spayed/neutered?*YesNoHave you ever surrendered or rehomed a pet? if so, why?*Have you ever had a pet euthanized? if so, why?*Do you have a routine veterinarian?*YesNoVeterinarian/Clinic Name*Clinic address*Clinic phone number*Which HHR dog are you interested in adopting?Please list experience with the breed of dog you're interested in adopting*Please describe where the dog will spend the day*Please describe where the dog will spend the night*If the dog is not house trained, how do you plan on dealing with that? are you familiar with crate training?*Average number of hours dog will spend alone?*Who will have primary responsibility for this dogs daily care?*Who will take financial responsibility for this dog?*Are you prepared and able to spend $500 on emergency care?*YesNoHow much money are you realistically willing and able to spend on health maintenance of dog?*Are you able to give dog regular exercise?*YesNoHow will you exercise the dog?Do you agree to provide regular healthcare by a licensed veterinarian?*YesNoAre you willing to let a representative of HHR visit your home by appointment?*YesNoHow did you hear about HHR?Please list three references who are familiar with both you and your pets. (none in same household, and only one family member, please)Reference #1*NameAddressPhoneRelationship Reference #2*NameAddressPhoneRelationshipReference #3*NameAddressPhoneRelationship All of the information I have given is true and complete. I understand that filling out this application does not guarantee the adoption of a HHR dog I AcceptBy clicking I Accept, you confirm that you have read the terms and conditions, that you understand them and that you agree to be bound by them.