Harlee's Angels Rescue: Dog Adoption Application

Rescue Dog Adoption Application
The adoption donation fee varies within divisions. Please contact the Division Director for the correct fee amount. Fee includes: vaccines, health exam, heartworm test, deworming and/or fecal, altered, and microchipped. If you are approved to adopt, please note: we do not accept personal checks. Adoption fee can be paid in the following ways: PayPal, Facebook Pay, Zelle, Venmo, Cash App or Cash. Please contact the Division Director to discuss which form of payment they accept. Transport and health certificate fee is an additional cost if you cannot personally pick up the dog in which you are applying to adopt.
Harlee's Angels Rescue reserves the right to reject any application based on information obtained during this screening process. Please understand that our primary goal is the health, happiness, and safety of our rescued dogs.
Name of the dog you want to adopt*
What breed of dog are you interested in adopting?*
What age range are you looking to adopt?
Adopter's Name*
First & Last Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Adopter's E-mail*
Company/Employer*
Occupation*
Co-Adopter's Name
First & Last Name
Co-Adopter's E-mail*
Phone Number*

Area CodePhone Number
Phone Type*

CellHomeWork
Harlee’s Angels Rescues definition of young child: A young child is any child who parent(s) deems the child too young to know better or doesn’t hold that child responsible for their actions. Example: your child hits, kicks, jumps on, hurts, ect., the dog and causes the dog to bite. The parent holds the dog responsible and not the child for the child’s actions. Therefore if your child is newborn or 17 and your household fits the example, please do not apply.*
Please type your name indicating you have read this.
Age range of the children in the home:*

0-12-34-56-89-1011-1213-1415-17No children
Do you currently have any pets?*

YesNo
If you currently have pets, please list them below.
Are your current pets altered?*

YesNoN/A, no current pets in homeNo, Will be within the next 30 days, appointment has been scheduled. (We will call your vet to verify this.)Other
If your current pets are not altered, please explain why below.
Are your current pets up to date on the Rabies vaccine?*

YesNoN/A, no current pets in homeOther
Are your current pets up to date on the DHPP vaccine?*

YesNoN/A, no current pets in homeOther
Are your current pets on Heartworm Prevention?*

YesNoN/A, no current pets in homeOther
Please list the brand of Heartworm Prevention.
Vet reference (please call your vet and give permission to release information to us)*
Vet name, address & phone number
Three Personal References*
Name, and Phone Number Please note: Application will NOT be processed if there are not 3 references listed.
Are you planning to move in the near future?*

YesNo
If moving soon, to what city/state?
What provisions have you made for your companion animal in the event of your illness or death?
Many people believe their family member or friends will take care of their beloved animals. Many animals are taken to the local shelter, most shelters are high kill and surrendered animals are the first to be killed for space. Please make sure you have spoke to your family and place the name of the family member or friend that has agreed to take your animal in your will.
When will you be ready to adopt this dog?*

TodayThis weekendWithin a weekWithin a monthNot ready yet, just researching
Are you in contact with any other rescues or shelters about a specific dog?*

Yes, application is pendingYes, just an email inquiry, no app yetNo, but I am looking at several dogs onlineNo, I am only interested in this particular dog
Are you going to meet another dog?*

YesNo
If so, when?
Is anyone in your home allergic to dogs?*

YesNo
Does anyone in your home fear dogs?*

YesNo
Does anyone in your home smoke?*

YesNo
Are you familiar with dog regulations in your area?*

YesNo
If you answered no to the question above, please contact your town/county/condo or homeowners assoc and ask them what the regulations are.
If yes, please describe local dog regulations and restrictions:
I/We live in a*

Single Family HomeDuplex/TwinCondo/TownhomeTrailerApartment
Do you rent or own this property?*

RentOwn
Do you live where there’s a HOA? Are there any restrictions on the breed or size of dog you can have? Do you have a limit on how many animals allowed? Please email a copy of the HOA regulations on animals to southernpugandbostonrescue@gmail.com

Yes, I have email a copy of the HOA regulations to tami@harleesangels.comNo
Renters, have you contacted your landlord to find out if there's any restrictions on the breed or size of dog you can have?

YesNoNot yet, but I willIt's written in our leaseOther
If you rent, you must show us a written letter from your landlord or a copy of the section of your lease stating that you are allowed to have dogs and showing any limitations.

If you live in a condo or townhome, you must show us written proof that you are allowed to have a dog there and show any restrictions.
Do you have a yard?*

Yard, fenced with a vertical fenceYard, fenced with invisible fencingYard, fence wooden privacyYard, fence wooden picketYard, fence chain linkYard, fence livingYard, no fenceNo yard (apartment/condo/townhome)
If vertical fence, what is your fence height?

2' high3' high4' high5' high6' high
Do you work outside the home?*

YesNoOne applicant is home/works from homeWe work different shifts
If you both work outside the home, how many hours per day are you away?*

1-44-88-1212-24Other
How many hours per day will the dog be left alone?*

1-44-88-1212-24Other
Please explain above answers on work or dog left alone hours here if need.
Have you discussed this adoption with all members of your household?*

YesNoYes, adults have discussed. Kids don't know yet.
We will be speaking to all adult residents to confirm everyone is aware of this application process and wants to have a dog added to the family. Please do not submit this application if you are "trying to talk someone into" adopting this dog or think "once they meet the dog, they will want one" or "I'm getting this dog as a surprise birthday present for them." In those scenarios, you are welcome to email us to discuss the dog, but we would like all adults in the home to be involved in that email discussion.
Based on the description in the dog's bio, do you feel pretty confident that you will be likely to adopt this dog upon meeting it?*

YesNoNot sure
Upon meeting the dog, what would give you cause to not want to adopt it? Please explain.*
Fantasy question: What would your dream dog be like? (If this dog is not a fit, we may be able to recommend another based on what you say here.)*
How much do you feel you can reasonably afford and would be willing to spend on your dog per year (for things like veterinary care, licensing, ID tag, food, toys, crate, other supplies, training, pet sitting, etc)? *
What activity/energy level do you prefer?*

Wild and crazy is coolLeash trained daily jogging partner would be excellentMedium energy, plays a bit then hangs out with youLow energy, walks slowly on leash, a total couch potatoOther
Please check all that apply. I want to adopt this dog...*

As a family petAs my child (fur child of course)To train/use for huntingTo train/use for agilityTo train/use as a therapy dogTo train/use as an assistance dog for the disabledTo use as a guard dogFor a jogging/hiking partnerTo interact with lots of friends/familyAs a gift for a friend, partner, or family memberAs a companion for my dog(s)As a companion for my cat(s)As a companion for my child/children
Please check all that apply. My adopted dog will...

Be kept indoors only and let outside only when supervised.Be kept outside most of the time while homeBe kept indoors most of the timeBe left outside during the work day while we are awayBe kept inside while we are awayBe crated when we are not homeHave free reign of the house when we are not homeBe taken to formal obedience classesBe trained by me/usTake frequent car rides with usBe kept on a lead line/cable in the yardBe mostly interacting with adultsBe interacting frequently with children under 8Be interacting frequently with older childrenMust be housebroken prior to adoptionWill be housetrained by usWill be walked more than one mile per day every dayWill be walked occasionallyBe attending formal group obedience classes with usBe trained by us without the advice of a trainerHave private sessions with a trainer as neededBe attending agility classesBe taking frequent car rides/trips with usBe boarded when we go on vacationStay with family when we go on vacationBe given away to someone else if we feel it's not a good match for usBe turned in to a shelter if we can't keep itBe going camping with usBe going on boat trips with usBe outside with a dog house in a fenced areaBe outside chained/tethered to a dog houseBe free roaming on the farm (unfenced)Other
Please take time to think, be honest with yourself and us when answering this question. What are you absolutely NOT willing to deal with at the time of adoption or at any time during the life of the dog?*

HousebreakingChewingJumpingPulling on leash during walksCounter surfingObedience trainingFear of menFear of womenFear of childrenMouthiness (may sometimes snag your hand or arm instead of the toy in play and will need redirection/training)GrowlingBarkingRough play with my dogHigh activity levelFood/toy aggression/not willing to share with other dogsFood/toy aggression with peopleWhining/cryingCounter surfingBlindnessLimited SightDeafnessSeparation AnxietyDiabetesSpecial DietLong Term MedicationIncontinence / Leaking UrineTaking classes with the dogGets stressed/carsick when riding in vehicleDoesn't know how to climb stairsCan't climb stairs due to age/arthritis/health issuesHeart conditionSkin allergiesFood allergiesTrimming nailsYeast on coat or in earsEar mitesFleasTicksHeartworm preventativeAnnual heartworm/lyme combo testingI will do whatever it takes to help this dog adjust and work with a trainer to help resolve any training needs.SheddingOther
Where will your companion animal sleep?*
Who will be responsible for the animal?*
Do you have any health conditions which could restrict your ability to care for an animal? If yes, please describe:*
How often do you go on vacation?*
Who will care for your companion animal when you go on vacation?*
Do you currently or have in the past foster or a volunteer with at rescue or shelter? If yes, please list the name and number of the rescue or shelter.
Have you ever had a special needs animal before? If yes, describe:
What would cause you to return a dog?*
Have you ever surrendered, returned, given away, sold or rehomed a dog? If yes, please explain.*
What do you feel is a reasonable amount of time for a dog to adjust to life with you/your family?*
How do you plan to integrate this dog into your family?*
What would you do if you discovered after adoption (at any time during the life of the dog) if your vet diagnosed an expensive health condition?*
Do you plan to get pet health insurance?*

YesNoI wasn't aware this was available. I will look into it.
What brand of dog food do you plan to feed?*
Grooming (please check all that apply)*

We use a professional groomerWe trim dog nails ourselves at homeWe bathe our dogs at home once a weekWe bathe our dogs at home once a monthWe bathe our dogs at home once every few months or whenever their coat feels dirtyWe bathe our dog twice a yearWe don't bathe our dogWe check ears weekly for infection/yeast/mitesWe check coat daily for ticks in spring/summer/fallWe clean teeth using home methodsWe take our dogs to the vet for dentals whenever the vet recommends this is neededPrefer a dog that doesn't shedDon't care about shedding
How long have you been looking for a dog?*
Do you plan to take formal obedience classes?*

YesNo
Additional reference (if desired)
Do you have any additional comments, questions or concerns? Anything else you would like us to know to help match you up to a dog?*
Are you interested in becoming a foster for the rescue?*

YesNoOther
Please read the above, check this box, sign, and click Submit.*

I/We have read and understand all of the above.
Applicant's Signature*

Clear
Co- Appicant's Signature

Clear
Signature date*
Should be Empty:

Rescue Dog Adoption Application