High Hopes

Adoption Center

Canine Adoption Application

Thank you for thinking about adding a canine family member to your home. We will use this application to help match you with the pawfect pup for you and your family! Please fill out this application as fully as possible. Our goal is to match each dog with a life-long family. We retain the right to refuse adoptions.

Is there a specific dog(s) you would like to adopt? Dog’s Name _______________________________________

Potential Adopters Information:

Name ___________________________________________________________ Phone: ________________________________

Address _________________________________________________________ Cell: __________________________________

________________________________________________________________ Work: _________________________________

Occupation _______________________________________ Place of Employment ___________________________________________

I [ ] Own [ ] Rent: a(n) [ ] Apartment [ ] House [ ] Trailer/Mobile Home [ ] Other ___________________________

(RENTERS: Landlord’s name and number __________________________ ______________ Does your lease allow pets? [ ] Yes [ ] No )

Length of time at this address: ______ [ ] I plan to move. When? ________ What will happen to this pet if you move? ________________

How many adults in household? ___________ Children? ___________ Ages of children: _________________________

Are all of the adults in the household aware of and approve of the idea of adopting a new pet? [ ] Yes [ ] No

How much time per day do you plan to spend: caring for __________, grooming ________, and playing with ________ your new pet?

What, if any, other animals live in the home? (list species, age, breed, and gender): _____________________________________________

________________________________________________________________________________________________________________

How much do you think a pet will cost in food, supplies, and routine medical bills each year?_________ Medical Emergencies? __________

Are you prepared to provide yearly vet care/vaccinations, wholesome food, and sufficient toys and supplies? [ ] Yes [ ] No [ ] Unsure

How many hours per day will your pet be left alone? ________ Where will your pet be while you are: home? ________ away? __________

What type of yard do you have? [ ] None [ ] small [ ]medium [ ] large Is your yard completely enclosed with a fence? [ ] yes [ ] No

Height of fence: [ ] 3 ft. [ ] 4ft. [ ] 6ft. [ ] other __________ I plan to keep my dog: [ ] indoors [ ] outdoors [ ] indoors/outdoors

I would like a dog that: (check all that apply)

[ ] gets along with other dogs [ ] gets along with cats [ ] gets along with children [ ] is good with the elderly

[ ] is house trained [ ] might need training [ ] only requires a little grooming [ ] might require regular grooming

[ ] likes to lay on my lap/by my feet [ ] is very laid back [ ] is somewhat active [ ] is very active and playful

I prefer a(n): [ ] adult dog [ ] puppy [ ] a senior dog

I’m interested in: [ ] two dogs that already get along [ ] two puppies [ ] a special needs dog

If you can not keep your new pet, do you agree to return it to the High Hopes Adoption center? [ ] Yes [ ] No

Do you agree to seek professional advice (from a Veterinarian, Behaviorist or HHAC) for behavior problems, if needed? [ ] Yes [ ] No

Will you allow a representative from High Hopes Adoption Center to visit your home? [ ] Yes [ ] No

I understand and agree that the information I have provided is subject to verification.

I certify that I am at least 18 years old and the information I have provided is true.

____________________________________________________________ ___________________________________

Signature Date

****************************************************************************************************************************************************************

Do Not Write Below This Line

________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________