Adoption Application
Harnessed to Hope Northern Rescue Breed
Name *
Address *
Email *
Phone number *
Personal References:
List three references (only one can be a family member)
Personal Reference 1 (Name, Relationship, Phone) *
Personal Reference 2 (Name, Relationship, Phone) *
Personal Reference 3 (Name, Relationship, Phone) *
How soon are you hoping to adopt a dog? *
Why did you select this timeframe? *
Please list all members of the household (name, age, relationship):
 *
Who will be the primary caretaker of the dog? *
Are there regular visitors to the home that the dog will intereact with? *
Required
Is everyone in the house agreeable to the adoption? *
Required
Do you own or rent your home? *
Required
If you rent, do you have landlord permission?
(RENTAL ONLY) Please provide the Landlord's Name and Phone Number
Rental Approval
If you rent your home, please hve your landlord fax a statement saying that your lease does allow you to have a dog.  Please ask them to include any limitations on having a god that your lease includes, such as maximum weight, prohibited breeds, etc.

The statement should be faxed to 866-657-3728 (this is our fax number as well as our phone number) to the attention of Harnessed to Hope Volunteer Staff.
How long have you lived at this address? *
Do you have plans on moving? If so, when? *
Do you have a fenced in yard? *
Required
If you answered 'yes' to having a fenced in yard, please describe your fence (type, height, etc.)
If you do not have a fence, do you plan to install one?  If 'yes', what kind (chain link, wooden, vinyl, picket, other)
If you do not have a fenced in yard, how do you plan to toilet and exercise your dog?
Have you researched the breed(s) that you are interested in? *
Required
What type of research have you done? *
Have you ever owned a: *
Do you currently have any dogs?  If so, please list each below w/ Sex, Age, Breed.  If no, specify "None". *
Have you ever owned a dog in the past 10 years that you no longer own?  If Yes, please explained what happened to the dog you no longer own. *
Do you have any cats?  If so, specify how many and if indoor or outdoor. *
Have your cats ever met a dog?  If so, how did they get along?
Do you have any other pets?  If so, please list here; otherwise, specify "none". *
What breeds or mixes are you interested in? *
Why have you chosen the breed/mix above? *
Is there a particular dog on our website that your interested in adopting?  If so, which one? (We do out best to match each adopter to the dog they like, but please note we cannon guarantee that this dog will still be available at the time of adoption.) *
If you are interested in a specific dog, why are you interested in this dog?
Do you have a gender preference? *
Required
Reason for gender preference?
Do you have an age preference? *
Reason for age preference? If 'No Preference', specify 'N/A'. *
Plans for dog: *
Characteristics: Please note the importance of each of these characteristics.  We will use this information to find the right match for you. *
Unnecessary
Willing to Train
Preferred
Essential
Housebroken
Crate Trained
Good With Babies
Good With Young Children
Good With Dogs
Good With Cats
Good With Small Dogs
Good With Small Animals
Trustworthy Off Leash
Trustworthy in House Alone
Has No Known Medical Issues
Good in Dog Parks
Doesn't Pull on a Leash
Does Not Dig
Where will the dog spend its time during the day? *
Required
Where will the dog sleep at night? *
Required
How many hours a day will the dog be alone? *
Required
Do you currently have a veterinarian? *
Required
Veterinarian Reference (Provide Name, Full Address, Phone Number)
Is this your current Vet? *
Required
As part of your adoption application, a volunteer with harnessed to Hope Northern Breed Rescue will need to contact your current vet (if applicable) as part of the reference check.  Some vets require that we have permission from you before they talk to us, Do you give your vet permission to talk with one of our volunteers? *
Required
Have your applied to any other rescue?  If so, which ones? *
Do you agree to allow a representative of HTHNBR to come to your home?  If no, why not? *
How did you hear about us? *
Is there any additional information that you would like us to take into consideration?
Attestation
Harnessed to Hope Northern Bred Rescue reserves the right to deny any application for any reason.

By clicking Submit below, you are attesting that all the information in this application is truthful.  Any falsehood or misrepresentation is grounds for denying the application.  You also agree that all members of the household are aware of and interested in adopting a dog, and will be at the adoption on the date agreed upon by you and by HTHNBR.
I agree to the above statement *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms