The Home Stretch Dog Haven Dog Application

The Home Stretch Dog Haven

Dog Adoption Application
Seeking to:

AdoptFoster
Name of dog, if known:
If you have a specific dog in mind, please list it here.
Contact Information
Full name
Occupation
Street Address*
City*
State*
Zip*
How long at this address
Daytime Phone
Evening Phone
Best time to call
Email address*
example@example.com
Family & Housing
How many adults are there in your family (their relationship to you)?
How many children and their ages?
Please describe your household:

ActiveNoisyQuietAverage
What type of home do you live in single family, town home, apartment, farm, etc.?
If you rent, please give the rules governing pets and the landlord’s name and number:
(By providing this information you are allowing the HSDH to contact your landlord. Please inform them of this call so they will speak with us)
Does anyone in the household have a known allergy to dogs?

YesNo
Is everyone in agreement with the decision to adopt a dog? ?

YesNo
Do you have time to provide adequate exercise, love, and attention?

YesNo
Other Pets
What other pets do you have (specify type and number)?
Are these pets up to date on vaccines??
Are these pets spayed/neutered?

YesNo
If no, why not?
Have you ever surrendered a pet?

YesNo
If yes, why?
Have you ever had a pet euthanized?

YesNo
If yes, why?
Have you ever lost a pet to an accident?

YesNo
If yes, explain
How do you discipline your pets and why?
Veterinarian
Do you have a regular veterinarian?

YesNo
Veterinarian’s name
Clinic Name
Clinic Address
Clinic Phone
About the Dog you Wish to Adopt
What is your idea of an ideal dog and why?
Desired age:
Desired size:
Desired breed:
Breed you would not adopt:
Desired sex:

Spayed FemaleNeutered MaleNo preference
Willing to adopt (check all that apply):

outgoing/hyper dogshy dogdog that needs regular medicationdog that needs trainingdog that needs groomingNone of these
Where will the dog spend the day? (describe )
Where will the dog spend the night? (describe)
Number of hours (average) per day dog will spend alone?
Who will have primary responsibility for this dog's daily care?
Who will have financial responsibility for this dog?
Do you agree to provide regular health care by a Licensed Veterinarian?

YesNo
Do you agree to keep the dog as an indoor dog?

YesNo
When the dog goes out, how do you plan to supervise it?
Do you have a fenced-in yard?

YesNo
Do you agree to contact HSDH if you can no longer keep this dog?

YesNo
Are you willing to let a representative of HSDH visit your home by appointment?

YesNo
How did you hear about HSDH?
Would you be interested in fostering?

YesNoWould like to know more
Personal References

Please list someone who is familiar with both you and your pets.
Name
Address
Phone
Relationship relative, neighbor, friend, etc
Name
Address
Phone
Relationship relative, neighbor, friend, etc
Attestation

All of the information I have given is true and complete. This dog will reside in my home as a pet. I will provide it with quality dog food, plenty of fresh water, indoor shelter, affection, annual physical examinations and vaccinations under the supervision of a licensed veterinarian.
(Signature)
(Date)

MonthDayYear
Date

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The Home Stretch Dog Haven

Contact Information

Family & Housing

Other Pets

Veterinarian

About the Dog you Wish to Adopt

Personal References