First Name*

Last Name*

Address*

City*

State/Province*

Zip/Postal Code*
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Email*

Home Phone

Cell Phone

Alt Email

Name of dog you are interested in*

Number of adults in the household?*

Ages of children in the household?

Please describe your household: (i.e. active, average, quiet...)*

Are you Employed?*
Choose one: Yes No

Length at current job:*

What experience do you have with animals?*

Does anyone in the family have a known allergy to dogs?*
Choose one: Yes No

Is everyone in agreement with the decision to foster/adopt a dog?*
Choose one: Yes No

Do you have time to provide adequate love and attention?*
Choose one: Yes No

How many hours a day do you work?*

Do you own or rent your home*
Choose one: Rent Own

Do you have home owners insurance or renters liability insurance?*
Choose one: Yes No

Is your yard fenced*
Choose one: No Yard Unfenced Yard Yard Partially Fenced Yard Completely Fenced

Have you ever owned a dog before?*
Choose one: Yes No

If you have a current vet, please include their information below. If not, please include who you plan to use.*

Please list your current pets, species, age and breed*

We will need to verify that current pets are current on vaccinations and are spayed/neutered. Are you able to provide this documentation?*
Choose one: Yes No

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

Have you ever had a pet euthanized? If so, why?*

Have you ever lost a pet to an accident?*
Choose one: Yes No

Are you aware of your cities ordinance regarding pets?*
Choose one: Yes No

Desired age of dog?*

Desired size of dog?

Breed/Mix of dog?*

Breed you would not adopt?*

What traits are you looking for in a pet

Where will the animal be kept when you are home*

Where will the animal sleep*

How much time will the animal spend alone during the day*

Who will have financial responsibility for this dog?*

Do you agree to provide regular health care by a Licensed Veterinarian?

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

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

Are you be willing to let a representative of HHMN visit your home by appointment (or virtual visit)?

How did you hear about HHMN?*

By submitting this application you agree to let HHMN contact and verify your references

Please provide three references with their contact information who will respond to our calls and messages. Are we able to text these numbers and best time to call? We will be contacting your references, please provide current information. *