www.hope4animals.org
e-mail
info@hope4animals.org
Phone
number 909- 801- 0012 fax
626 – 795 – 5769
Mailing address - P.O. Box 2349
Pasadena C.A. 91102-2349
To be completed by our representative:Dog adopted - Name
_____________________________________
Age /Sex _______________ Breed/Color
____________________________________________________
F. P Name
_____________________________________________________________________________
F. P phone
number
______________________________________________________________________
Name of dog (s) you are interested in _______________________________________________________
Name of spouse / partner _______________________________________________________________
Or roommate__________________________________________________________________________
Street address ________________________________________________________________________
City __________________________________________________________________________________
State ____________ Zip _________________________________________________________________
Home phone ___________________________ Work phone ____________________________________
Cellular phone ___________________ e-mail _________________________________________________
Occupation ____________________________________________________________________________
Spouse’s occupation _____________________________________________________________________
Work schedule _________________________________________________________________________
Spouse’s hours _________________________________________________________________________
Names of all persons living in your household, their relationship to you and their ages:
_______________________________________________________________________________________
Does EVERYONE in your family want to adopt this dog? Yes _________No ________
Please list a personal references and their relationship to you:
Relationship _______________________________________________Phone _______________________
Name _________________________________________________________________________________
Type of dwelling? House _______ Apt _______ Do you own _______ or rent?_______ Military _______
If you live in a Condo or Apartment what are the association’s rules about pets?
_____________________________________________________________________________________
Your home has: 1 story_____2 stories _______a pool? Yes________ No____________
How do you introduce a dog to Pool? ______________________________________________________
______________________________________________________________________________________
If you have a pool, is it fenced?____________________________________________________________
Would you object to an inspection of your home by a rescue volunteer?
Yes_____No _____
If not a home owner, do you have the landlord’s permission to have a dog?
Landlord’s name ________________________________Phone _________________________________
Do you
have the financial means to spend hundreds or even a few thousands of dollars
on
veterinary care for your pet should the need arise?
Do you presently have a dog? Yes __________ No ___________
Have you previously had a dog? Yes ________ No ____________
If you
presently have dogs or had dogs in the past, please complete the charts below.
In the column, “what happened,” write: gave away, sold him/her, took to the
pound,
died, etc. (If the dog died, please state cause of death.)
CURRENT DOG(S)
Name & Breed ______________Age _____ Sex Altered? ___________________________________________
How & Why Obtained? _______________________________________________________________________
How long have you have the dog?_______________________________________________________________
PREVIOUS DOG(S)
Breed Age Sex Altered? Kept In/Out/What Happened? When?(yr)
Have any of your dogs ever had puppies? Yes ______ No ________
If yes, you breed for: Fun ___Profit ___ Show ________ Accident
Has any member of your family ever experienced animal-related allergies? Yes _ No _
Have you ever trained a dog in obedience classes? Yes ________No ______________
If you have other pets, please complete the following chart:
Species How many? _______ Ages _________________ Kept where? ______________________________
How long did you have your dog/cat? _________________________________________________________
If cat, de-clawed? yes _____________ No _________________
Your Family Veterinarian
Name: _______________________________________________ Phone: ____________________________
YOUR NEW DOG
Who would be responsible for the care of the dog? _______________________________________________
What is your primary reason for adopting a dog? ________________________________________________
Where would the dog sleep? Inside (where?) _______________________ Outside (where?) ______________
How many hours per day would the dog be left alone? _____________________________________________
Where would the dog be left when he/she is alone or when you are away from your
home? Indoors _________________________________________ Outdoors _______________________
If outdoors: Yard ______ Patio ________ Kennel ____________ Garage ___________ Other _________
If yard is fenced ___________ foot high and what kind of fence ie: wood, chain link etc ______________
Do you have a doggie door? Yes ____ No ____
Do you intend to hire a dog-sitter or take the dog to the daycare center? Yes __________ No _____
When you are at home, the dog would be:
always indoors ____mostly indoors ____always outdoors ___________mostly outdoors ________
If the dog will be outside at all, what outside space is available for the dog:
Fenced Yard _________Patio ________________Run ________________________Balcony___________
unfenced yard _______________Other:______________________________________________________
How do you plan to handle dog’s exercise needs? _____________________________________________
Do you feel obedience training makes a dog a better companion? Yes _________ No________
If necessary, would you be willing to attend obedience classes at your own expense?
Yes ____________ No ______________
Do you travel a great deal? Yes__________________ No __________________________
How often? __________________How long at a time? _____________________________
When you do travel, how do you intend to provide for the dog while you are gone?
___________________________________________________________________________________
What provisions would be made for the dog if you had to move?
Locally? _____________________________ Out of state? ___________________________________
To a place where no pets are allowed? ___________________________________________________
Under what circumstances would you not keep the dog? ___________________________________
Divorce __Illness in family __Moving __New baby __New job __Housetraining problem __
Chewing__ Barking__Digging__Biting__Allergy __Shedding__Dog grew too big __Medical
bills__Kids ignore the dog__Pets didn’t get along__ Not obedient enough__Other
(please explain) _______________________________________________________________________
If the dog became destructive at your home. what would you do?
_____________________________________________________________________________________
Do you have any “musts” for this dog to perform? If yes, please elaborate:
What
would you do if the dog grew to be bigger than you expected? Return the dog to
rescue / take the dog to shelter / keep the dog but keep him outside.
______________________________________________________________________________________
The dog may live 15+ years, what would you do with your dog if you could no longer care
for the dog_______________________________________________________________________________
Is there anything else you would like to tell us about yourself or your home environment?
________________________________________________________________________________________
_______________________________________________________________________________________
Application Information: All of the information I have provided in this application is true and
correct. If any of the information changes, I will advise you promptly.
Signature ________________________________________________________Date: __________________