Adoption Application
Name
First Name
Last Name
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Age of adopter
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of dog applying for
Do you own or rent?
*
Own
Rent (Pets must be allowed by owner)
Will there be children in the home?
Yes
No
If you answered yes above please list ages below:
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Have you ever had to surrender or give away a pet?
Yes
No
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Reason for surrender
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Please list all pets currently in the household
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Would you adopt a dog with medical issues?
Yes
No
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Where in the home will pet sleep?
Inside
Outside
How many hours per day will the dog be alone?
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Are you willing to house train your dog if not housebroken?
Yes
No
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How do you plan to address possible behavior issues?
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I understand that Henderson Home Animal Rescue is not able to guarantee the health or temperament of the dog being adopted. I hereby release Henderson Home Animal Rescue from all liability once the dog is adopted.
Submit
Should be Empty: