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Name:
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Email Address:
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Home Address:
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City, State, Zip:
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Your Date of Birth:
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Phone Number (Best way to reach you):
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Occupation:
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With Whom Do You Live?
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If you selected other please describe:
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Do you have children in your household?
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If yes, please provide ages of children:
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If no, do you plan on adding children in the future?
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Do you rent or own your home?
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Do you live in an area where Breed Specific Legislation has been passed?
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Name of the dog you are interested in?
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Characteristics of personality traits you are looking for in a dog?
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I love dogs that:
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I can not tolerate dogs that:
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Any reasons you would give up your dog (moving, unable to housetrain, chewing, barking, etc.):
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Where will the dog be kept?
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Is your yard fenced?
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If so, please describe fence condition:
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Is a crate available? If not, would you purchase one?
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How will the dog be exercised?
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Do you have other animals?
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If yes, please provide breed, sex, age and any additional information on each:
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Are you current animals spayed or neutered?
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Please list all animals you have owned in the past 5 years, along with reasons for no longer owning any of these animals.
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Have you ever adopted from a rescue group or shelter before?
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If so, please provide name and contact info for group or shelter.
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Are you willing to continue training with a behavior consultant?
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Please list any experience you may have had with the current breed you are applying to adopt.
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Sometimes unforeseen accidents happen to dogs or severe medical conditions appear. Are you prepared to pay for the costs of these unplanned expenses?
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Do you have a back-up plan if an emergency should arise?
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Name and telephone number for current veterinarian? If no current vet, please provide name of a vet you have used in the past.
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Please list the name and phone numbers of three personal references that we may contact regarding the adoption.
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Is there any additional information you would like to share with HOGPR?
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How did you hear about Hearts of Gold Pit Rescue?
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When you click submit
at the end of this application you may be directed to an
advertising page not affiliated with HOGPR. You do not need to
fill out any of the information once you have clicked submit at
the bottom of the application and then filled in the four-digit
security code. You do not need to answer any of the questions
once the top of the page reads FORM SUBMITTED. Rest
assured, your information and application has been emailed to
us. If you do not hear back in a couple of days, please email
heartsofgoldpitrescue@yahoo.com for more information.
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