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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?*
Length at current job:*
What experience do you have with animals?*
Does anyone in the family have a known allergy to dogs?*
Is everyone in agreement with the decision to adopt a dog?*
Do you have time to provide adequate love and attention?*
How many hours a day do you work?*
Do you own or rent your home*
Do you have home owners insurance or renters liability insurance?*
Is your yard fenced*
Yard Partially Fenced
Yard Completely Fenced
Have you ever owned a dog before?*
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?*
Have you every 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?*
Are you aware of your cities ordinance regarding pets?*
Desired age of dog?*
Desired size of dog?
Desired 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. *
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