Adoption Application

Adoption Application
Name of the dog you are interested in:
Today's Date

YearMonthDay
Date
Your Name:*

First NameLast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number

Area CodePhone Number
Cell Number

Area CodePhone Number
About Your Family:
How many people live at this residence:*
What are the ages of everyone who lives here:*
Do any children live/spend time here:*
If yes, what are their ages:
Does everyone in the home want to adopt a dog at this time:*
Does anyone in the house have allergies:
Do all the adults work outside the home:*
How many hours each day will the dog be alone:*
Has anyone in the home ever adopted from a rescue/shelter before:*
If yes, which rescue/shelter:
Has anyone in the home ever been denied an adoption before:*
If yes, please explain why:
What is the general activity level like in the home (active, loud, quiet, calm, etc.):*
What is the general activity level like outdoors (gardening, long walks, sports, etc.):*
Has anyone at this address ever been charged or convicted of animal cruelty or neglect under any municipal, provincial, or federal law or regulation:*

YesNo
About Your Home:
Is your home a:*
Do you own or rent this residence:*
If you rent, please provide the name and phone number of your landlord:
Do you have somewhere to exercise a dog:*
Is your yard fully fenced:*
If not, how will you contain the dog:
About Your Current Pets:
Do you currently have any dogs:*
If yes, how many:
If yes, are they spayed/neutered:
If yes, are they vaccinated:
If yes, what breed(s) are they:
Are they good with other animals:
Do you currently have any cats:*
Do you have any concerns with the cats meeting/living with a new dog:
Have any of your animals ever bitten or caused injury to a person or to another animal:*
If yes, please explain:
Describe your current pets (likes, dislikes, where did you get them, etc.):*
Name of your Veterinarian*

First NameLast Name
Clinic Name:*
Veterinarian/Clinic phone number:*

Area CodePhone Number
About What You Are Looking For:
Age you would prefer to adopt:*
Gender you would prefer to adopt:*
If a dog comes in that matches your home but is not the age/gender that you prefer, would you consider another dog for adoption or would you prefer to wait:*
Please check all behaviours/traits that are important to you:

Quiet IndoorsKnows Basic ObedienceQuiet OutdoorsCalm/laid backGood with catsGood with other dogsGood with childrenHousetrainedGood off-leashCrate trainedActive/bouncyOther
What behaviours/traits would you find totally unacceptable, or would not work in your home:*
General Information:
Why are you interested in adopting a dog at this time:*
Do you have experience with herding breeds:*
Do you understand that herding breeds are known to be a bit "barkier" than other breeds and manywill "alert bark" to anything from people walking past the house to leaves blowing in the yard:*
If the dog you are interested in would benefit from an obedience class and HAR recommends attending classes as a condition of adoption, will you follow through and enroll/attend obedience classes:*
Additional Information: If you would like to add anything you feel we should know about your family, your home or what you are looking for, or if you would like to expand on any of your answers above (or to clarify any "other" choices above), please us this space:
*IMPORTANT INFORMATION BELOW*

Please read carefully before submitting this application
Do you understand that Herd About Rescue makes NO warranties as to the temperament, habits, behaviours or health of any dog you should choose to adopt and all adoptions are based solely on your own judgement?*

Yes, I understandNo, I do not understand
Do you understand that Herd About Rescue requires a donation of $500 to help off-set some of the costs incurred by the dog while in the care of the rescue:*

Yes, I understandNo, I do not understand
Do you understand that completion of this adoption application is in NO WAY considered approval or acceptance as an adopter and is used only as a tool and that Herd About Rescue reserves the right to refuse any adoption, for any reason, at any time?*

Yes, I understandNo, I do not understand
Do you state that the information provided on this application was filled in by the person applying to adopt a dog from Herd About Rescue and that all information is true and accurate to the best of my ability?*

Yes, I understandNo, I do not understand
Should be Empty:

Adoption Application

About Your Family:

About Your Home:

About Your Current Pets:

About What You Are Looking For:

General Information:

*IMPORTANT INFORMATION BELOW*

IMPORTANT INFORMATION BELOW