Adoption Application - Dog - Updated 4/2019 Thank you for your interest in adopting a dog! To help find the best match possible, please complete this form. First Name * Last Name * Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Primary Phone * Alternate Phone Email * Are you under 21 years of age? * No Yes Date of Birth * Please tell us about your household. How many people do you have in your home? * How many of those people are children? * Do you have small children (5 years or younger) or have small children who frequently visit your home? * Yes No Are the people in your home ready and willing to add a dog member to your family? No Yes Which of these applies to you? * I live in a house I own I live in a house I rent I live in a condo/apartment I own I live in a condo/apartment I rent I live in a mobile home I own I live in a mobile home I rent Our home is: * Active Quiet/Low-key Somewhere in between We understand an average annual cost of caring for a dog is $1,500, and a puppy's first year can average $2,000. * No Yes Have you had a dog before? * Yes No Do dogs frequently visit your home? * Yes No Please tell us about your pet history over the past few years. Pet's Name Species/Breed Age Where is your pet now? Currently in home Deceased Living elsewhere Add another pet Remove this pet Please tell us about a dog you'd like to adopt. Is a dog who is easy to walk... * A must Doesn't matter Is a dog who is active or playful... * A must Doesn't matter Is a dog who is quiet... * A must Doesn't matter Is a dog who loves other dogs... * A must Doesn't matter Is a dog who is okay being alone... * A must Doesn't matter Is a dog who jumps up... * A definite no Can train Is a dog who is mouthy/plays rough... * A definite no Can train Is a dog who destructively chews... * A definite no Can train I’m interested in a special needs dog, with known medical needs * No Yes I’m interested in a special needs dog, with behavioral needs (e.g., shy or rough play personality) * No Yes We are adopting for * Our family Our child(ren) Another family member Companion for another pet Guard dog When we are not home, our dog will spend time * In a crate in the house Loose in the house Confined in one room In the yard Other:Other: Our dog exercise plans are * Leash walks Hiking, Running or Other outdoor activities Dog Park Obedience or Agility Training Other:Other: We'll review the dog's medical history and behavior notes with you. Please let us know any other topics you'd like to discuss. I'd also like to discuss Acclimating this dog to our home Introducing this dog to our resident pets House and crate training Training Toys & fun Preventatives (i.e., for heartworm, flea & tick) Moving with pets Introducing pets to a baby Do you have a veterinarian already? * Not yet Yes, and here's the vet practice name:Yes, and here's the vet practice name: If you're interested in a particular dog, please write her/his name here: - Yes, add me to the HSHV email list for the latest promotions and updates from HSHV. Submit If you are human, leave this field blank.