Houston Eskimo Rescue Adoption Request Form
Applicant Information
Full Name
*
First Name
Last Name
Your Age
*
Spouse's Name
First Name
Last Name
E-mail
*
example@example.com
Home Address (Street Address, City, State/Province, Postal/ZIP Code, Country)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Phone
*
Format: (000) 000-0000.
Work Phone
Format: (000) 000-0000.
Your Occupation
Spouse's Occupation
Household Information
# Of People Living in Your Home
*
Household Member #1 - Name
First Name
Last Name
Household Member #1 - Age (Years)
Household Member #2 - Name
First Name
Last Name
Household Member #2 - Age (Years)
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Household Member #3 - Name
First Name
Last Name
Household Member #3 - Age (Years)
Household Member #4 - Name
First Name
Last Name
Household Member #4 - Age (Years)
Current Pets
Current Number of Pets
*
Pet #1 - Name
Age (Years)
Sex
Male
Female
Species
Breed
Spay/Neuter
Yes
No
Vaccinations
Pet #2 - Name
Age (Years)
Sex
Male
Female
Species
Breed
Spay/Neuter
Yes
No
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Vaccinations
Pet #3 - Name
First Name
Last Name
Age (Years)
Sex
Male
Female
Species
Breed
Spay/Neuter
Yes
No
Vaccinations
Pet #4 - Name
First Name
Last Name
Age (Years)
Sex
Male
Female
Species
Breed
Spay/Neuter
Yes
No
Vaccinations
Veterinary Information
Vet Clinic's Name
*
Vet's Name
First Name
Last Name
City
*
Phone
*
Format: (000) 000-0000.
Additional Vet Info
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American Eskimo Dog Experience and Home
Why are you considering an American Eskimo Dog as opposed to other breeds?
*
Have you ever owned an American Eskimo Dog? Please Explain
*
What kind of home do you live in?
*
Do you own or rent your home?
*
Own
Rent
If you rent, do you have your landlord's permission to keep a dog?
Do you have a fenced area, yard or kennel? If so, please describe the area.
*
Where will the Eskie live & sleep? Please explain fully.
*
Where do your current pets live & sleep? Past Pets? Please explain fully.
*
Care, Safety, and Training
How will you exercise your American Eskimo Dog? How often? Please explain fully.
*
When you must transport your American Eskimo Dog, how will the dog be restrained/contained in your vehicle to ensure his/her safety?
*
How will your Eskie be maintained while you are at work or on vacation?
*
What is your idea of proper discipline for an American Eskimo Dog?
*
What is your idea of proper and nutritious food for a dog?
*
Does everyone in your household want an American Eskimo Dog?
*
Yes
No
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Will you agree to attend at least one session of obedience training with your American Eskimo Dog if necessary?
*
Yes
No
Do you understand that if you are ever unwilling or unable to keep a dog received through Houston Eskimo Rescue, the dog must be returned to Houston Eskimo Rescue?
*
Yes
No
Adoption Preferences
Please describe the characteristics you would like your American Eskimo Dog to have (age, sex, size, temperament, etc.).
*
Will you consider adopting a heartworm positive dog? (We will provide medication for slow kill treatment)
*
Yes
No
What behavior(s) would make you decline/return a dog?
*
Have you seen a particular dog on our site or Petfinder listing that you are interested in meeting?
Additional Comments
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