Happy Tails Retriever Rescue Adoption Application form
First Name *
Please enter your first name
Your answer
Last Name *
Please enter your last name
Your answer
Street Address *
Example: 1234 Main Street
Your answer
City *
Please enter your city name
Your answer
State *
Example: FL
Your answer
Zip Code *
Please enter your zip code
Your answer
Phone Number *
Example: 850-123-4567
Your answer
Alternate Phone Number
Example: 850-123-4567
Your answer
Email Address
Your answer
Preferred Contact Time *
Please indicate the best time of day to contact you.
Referred to HTRR by: *
How did you learn about Happy Tails Retriever Rescue (HTRR)
Dog Name and ID#
Please list the name and ID # of the dog you are interested in.
Your answer
Preferred Dog Gender *
Please list the gender of the dog you would like to have.
Preferred Age Range *
Select or list the age range that best describes the age of dog you would like to adopt.
Preferred Breed *
Please indicate if you would be interested in a pure or mix breed
Considering Special Needs Dog *
Would you adopt a special needs dog? Example: a blind or deaf dog, or a senior dog
Reason for Adopting *
Briefly (in 20 words or less) explain why you would like to adopt a rescued dog.
Your answer
Do You Rent or Own Your Home? *
Property Description *
Briefly describe your property. Example: fenced back yard...
Your answer
Time at Residence
How long have you lived at this address?
Your answer
Ages of All Members in Household
Your answer
Household Activity Description *
Choose what most accurately describes your lifestyle.
Allergies/Medical conditions
Is there anyone in the home that has allergies or other medical conditions that need to be taken into consideration before adopting a dog?
Who Will Care for the Dog? *
Your answer
Prior/Current Pets
Briefly (in 20 words or less) list all prior and current pets in the home. Example: 3 yr old Pug, 1 yr old Golden
Your answer
Any Problems with an Addition? *
Do you foresee any problems with adding another pet to the home?
Familiar Breeds
Briefly describe the breeds you are most familiar with. Example: Labs, Poodles, Shepherds.
Your answer
Prior Likes
Briefly explain what you like most about dog ownership?
Your answer
How Long Will the Dog Be Alone? *
Select the best choice
Where Will the Dog Reside/Live? *
If Applicant Had to Move, What About the Dog? *
Select the best choice
What type of heartworm preventative is/will be used?
Your answer
Has Applicant Had Any Past Surrenders to a Shelter? *
Vet Name, Address and Phone Number
Please list the Name, Address and Phone Number of your current vet.
Your answer
Does Applicant Understand Local Regulations *
Will Applicant Adopt a Dog without Meeting it First? *
Signature of Applicant *
Typed Name of Applicant
Your answer
Today's Date *
Signature of Co-applicant
Typed Name of Co-applicant
Your answer
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