HBPR Dog Adoption Questionnaire

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Adopting a pet is a lifelong commitment that should be taken seriously. We strive to match owner lifestyles with pet personality, special needs and breed type so that your pet will benefit from a healthy, fulfilling relationship. Please start the process by taking a few minutes to fill out this questionnaire and submit it using the Submit button at the bottom of the page.

Applicants must be 21 years or older. * = Required information

HBPR Dog Adoption Application

CONTACT INFORMATION
First Name: *
Last name: *
Your age *
Co Applicant First Name: *
Co Applicant last name: *
Co applicant age *
Street Address: *
Additional Street Address:
City: *
State: *
Zip code: *
Cell Phone number: *
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?	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? *
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?
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? *
Have you ever had a serious behavior problem with a previous pet?
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 *
How did you hear about Homeward Bound? *
Typing your name below will serve as legal signature. By signing below, I am attesting to the truthfulness of my answers. Falsification of any of the above information will be grounds for disallowing the adoption of our rescue animals and possible removal of said animal from my home. Applicant must be 21 years of age or older. Homeward Bound reserves the right to refuse any applicant.
Please enter your name and submit the application: *

Homeward Bound Pet Rescue Inc. | PO Box 792 | Ellijay, GA | 30540 | 706-698-4663