Adoption application form

Personal information

Full Name *

Occupation *

Full address including postcode

Email Address *

Home phone number

Mobile phone number

Best time to contact you?

Family & Housing Information

How many adults are there in your family (their relationship to you)?

How many children (ages)?

Accommodation Type

Please describe your household

If you rent, please give permission in writing (Upload the written permission here)

Does anyone in the family have a known allergy to dogs?

Yes

No

I don't know

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

Yes

No

I don't know

Do you have time to provide adequate love and attention?

Yes

No

I don't know

Other Pets

What other pets do you have (specify type and number)?

Is there anything else you would like us to know that you feel important in your role as an adopter?

Are these pets up to date on vaccines?

Yes

No

I don't know

Are these pets spayed/neutered? If not, why?

Have you ever surrendered a pet? If so, why?

Have you ever lost a pet to an accident?

Yes

No

I don't know

How do you discipline your pets and why?

Your Vets Information

Do you have a regular Veterinarian?

Yes

No

I don't know

Permission to contact your Vet

Yes

No

I don't know

Vet's Name

Vet's Address

Vet's phone number

About the Dog You Wish to Adopt

Name of the dog you wish to adopt *

Desired age

Desired size

Desired breed

Desired sex

Breeds you would NOT adopt

Willing to adopt

Where will the dog spend the day? (describe)

Where will the dog spend the night? (describe)

Number of hours (average) the 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?

Yes

No

I don't know

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

Yes

No

I don't know

When the dog goes out, how do you plan to supervise it? Fenced garden?

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

Yes

No

I don't know

Are you willing to allow a representative of HHDR to visit your home by appointment?

Yes

No

I don't know

How did you hear about HHDR?

Would you be interested in fostering?

Yes

No

I would like to know more

I don't know

Your Confirmation

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 examination and vaccinations under the supervision of a licensed Veterinarian. *

I agree

I disagree

I don't know

By using this form you agree with the storage and handling of your data by this website.

Personal information

Family & Housing Information

Other Pets

Your Vets Information

About the Dog You Wish to Adopt

Your Confirmation

Welcome back,