Dog Adoption Application

Dog Adoption Application

Standard online adoption application for The House of Hope Animal Sanctuary and Rescue. Please complete all required fields, review the waiver and consent statements, and sign at the end.
Applicant Information
Full Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
City / State / ZIP
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Occupation
Employer
Co-Applicant (if any)
Relationship to Co-Applicant
Housing and Household Information
Do you rent or own your home?
If renting, do you have landlord approval to adopt?
Landlord Name
Landlord Phone
Please enter a valid phone number.Format: (000) 000-0000.
Type of home
Fenced yard?
Fenced yard height
Number of adults in household
Children (ages)
Are all household members in agreement with adopting a dog?
Does anyone in the home have allergies to animals?
If apartment or condominium, can you enter and exit without encountering other dogs or people?
If apartment or condominium, describe entry/exit situation
Pet History and Care Plan
Have you owned dogs before?
Current pets
Past pets
How many hours per day will the dog be left alone?
Where will the dog stay during the day?
Where will the dog sleep at night?
How often do you travel? Who will care for your dog while you are away?
Have you ever surrendered a pet to a shelter or rescue? If yes, please explain.
Veterinary and Reference Information
Veterinarian Name / Clinic
Veterinarian Phone
Please enter a valid phone number.Format: (000) 000-0000.
Veterinarian Address
May we contact your veterinarian for a reference?
Personal Reference 1 - Name
Personal Reference 1 - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Personal Reference 1 - Relationship
Personal Reference 2 - Name
Personal Reference 2 - Phone
Please enter a valid phone number.Format: (000) 000-0000.
Personal Reference 2 - Relationship
Adoption Preferences and Payment
Preferred dog size
Preferred age
Energy level desired
Open to adopting a dog with medical or behavioral needs?
Specific breeds or traits you prefer
Dogs you are interested in
Adoption Fee Amount
Payment Method
Consent, Waiver, and Agreement Statements
I understand the adoption fee is generally non-refundable, except at the Rescue's discretion.
I agree
I agree to provide proper care and keep the dog as an indoor family companion.
I agree
I understand the Rescue cannot guarantee temperament, future health, or behavior.
I agree
I agree to return the dog to the Rescue if I can no longer care for it and will not transfer ownership without permission.
I agree
I consent to reasonable follow-up communication and home visits and understand the Rescue may reclaim the dog if neglected or unsafe.
I agree
I understand the Rescue may take legal action if I fail to comply with this agreement.
I agree
Extended Limited Liability Waiver - I acknowledge the risks of interacting with and adopting dogs and assume all such risks.
I agree
Extended Limited Liability Waiver - I release and hold harmless the Rescue and its affiliates from claims or liability related to the dog.
I agree
Extended Limited Liability Waiver - I accept full financial responsibility for all costs associated with the adopted dog.
I agree
Extended Limited Liability Waiver - I agree to indemnify and defend the Rescue against third-party claims related to the dog.
I agree
Agreement to Arbitrate - I agree that disputes will be resolved by binding arbitration under Virginia law.
I agree
Signatures
Applicant Signature
Applicant Signature Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Co-Applicant Signature
Co-Applicant Signature Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Rescue Representative Signature
Rescue Representative Signature Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

Dog Adoption Application

Applicant Information

Housing and Household Information

Pet History and Care Plan

Veterinary and Reference Information

Adoption Preferences and Payment

Consent, Waiver, and Agreement Statements

Signatures