CONTACT INFORMATION
First Name: *
Your first Name
Last name: *
What is your last name?
Your age *
Co Applicant First Name: *
Co applicant's (if any)first name:
Co Applicant last name: *
Co applicant (if any) last name:
Co applicant age *
Street Address: *
What is your street address used for mailing
Additional Street Address:
City: *
What is the town or city?
State: *
What is the state?
Zip code: *
What is your zip code?
Cell Phone number: *
What is your mobeile phone number?
Email address: *
What is your email address?
PET INFORMATION
Name of animal you are interested in. You may enter multiple ANIMAL names.... *
Are you willing to allow a representative from Homeward Bound to visit your home by appointment?
Are you willing to allow a representative from Homeward Bound to visit your home by appointment?
Yes No
HOUSING INFORMATION
Please indicate where you live:
apartment
house
condo/townhouse
trailer/mobilehome
Do you......................................................................................................
rent your home
own your home
If you rent, do you have the landlord's written permission to own a dog?
Yes No
What is the apartment complex name?
What is the landlord's phone number?
How much is the pet deposit?
BACKGROUND INFORMATION
How many times have you moved in the past 5 years? *
If you move, will your pet go with you? *
No Yes
Can you provide a permanent home for this dog for 12-18 years?
Yes No
Do any children live in the house? If so, what are their gender/ages? *
Please describe the number, type and age of pets currently in household
Are all current pets spayed/neutered?
Yes No
What is your veterinarian's name and phone number?
Do we have your permission to contact your vet? *
No Yes
We expect the average annual cost of pet care (vet visits, medication, vaccines, monthly preventatives, food, grooming, etc.) to be between $1000. - $1200. Are you able to provide that?
No Yes
How many dogs have you owned in the past? If any, please describe what happened to each of them (put to sleep, run over, died of old age, sold, given away, ran away, etc.) *
How many hours will the dog be home alone on a typical day?
Do you have a fenced yard? *
I do not have a fenced yard
My fence is a 4ft chain link fence
My chain link fence is taller than 4ft
My fence is a 4ft picket fence
My fence is a 6 ft (or taller) privacy fence
Have you ever had a serious behavior problem with a previous pet?
No Yes
If yes, please describe
Have you always kept an ID tag (other than a rabies tag) bearing your phone number on your pets?
Yes No
Are you willing to keep a collar and ID tag on all of your pets including a new dog at all times?
Yes No
If you are unable to keep your dog for any reason at any time will you return the dog to us?
Yes No
Please list the names, addresses and phone numbers of 2 personal references that are not related to you:
Please provide the name and phone number of someone to contact in an emergency *
An emergency contact name and number
How did you hear about Homeward Bound? *
Select One
Friends or Family
Google
Facebook
Local Paper
TV
Saw You At An Event
Please enter your name and submit the application: *
