Helping Hounds Adoption Application

All questions marked with the red asterisk must have an answer in order to submit your application.

This adoption application is a general application for your ability to adopt and is not for a specific dog.

First Name *
Last Name *
Is there a spouse/ partner/ significant other living in the home? *
Spouse/ Partner/ Significant Other's FULL Name Spouse/ Partner/ SO FULL name (FIRST and LAST) Leave blank if not applicable.
Street Address w/ apartment number if applicable *
City *
State *
Zip Code *
County * (Onondaga, Madison, Jefferson, etc.)
Home Phone Number * Please use the following format 248-555-1212
Alternate/Cell Phone Number *
Email Address * Please enter correctly as this is the main way we will contact you.
Employment Status *
If you answered "Self Employed" or "Other" above, please explain
Employer's Name *
Spouse/ Partner/ Significant Other's Employer Type NA if none
Do you own or rent your home? *
Please select your current residence type. *
Landlord's/ Home Owner's Name *
Landlord's/ Home Owner's Phone Number *
Veterinarian(s) * Select all that apply
If Other, Veterinarian Name(s) * List all that apply
Veterinarian's Phone Number(s) or "None" if First Time Pet Owner * List all that apply
Owner's Name on vet records. *
I understand that I must call my vet and give them permission to discuss my pet's records with Helping Hounds *
Are there any pets currently living in the home? *
If yes, please list their names, breeds, genders and ages. *
Age of Applicant *
Age of Spouse/ Partner/ Significant Other
Please list the names, ages & relationship of those who live in your home. *
Personal Reference Name [friend or relative not living in same household that has known you at least 2 years] (REQUIRED) * A friend or relative who does not reside in the household.
Personal Reference Phone Number (REQUIRED) *
We must hear from your reference before we can process your application. Please have your reference call the rescue at 315-446-5970 and choose option 1 to provide a reference. I understand it is my responsibility to have my reference contact HHDR on my behalf and will request they call the rescue. *
Please describe your level of experience in pet ownership. *
On average, how many hours per day will your pet be left alone? *
Describe Your Home Environment *	Grand Central Station Some Activity Very Calm and Consistent
To help us better match you with a dog, please tell us what role the dog would play in your home. *
Please tell us how you would correct the dog's unwanted behaviors. *
What is your daily exercise plan for the dog? *
Describe what life would be like for a dog that joins your family. *
Occasionally a dog will need help making the adjustment to their new home. Please let us know what you are willing to do in order to make the adoption successful? *
What do you expect to be the hardest part about adopting a rescue dog and how do you plan to address it? *
If you become ill or pre-decease your dog, who would continue providing care for the dog? *
Any veterinary problems that may arise post-adoption, including serious illness requiring emergency care or surgery, are your responsibility and you are responsible for all related costs. *
I understand HHDR reserves the right to refuse adoption to anyone. Adoption approval and refusal decisions are made soley at the discretion of Helping Hounds. *
The applicant/potential adopter and his/her spouse, heirs, executors, personal representatives and assigns agree(s) hereby releases Helping Hounds Dog Rescue and its directors, officers, employees, agents, representatives, contractors, volunteers, successors and/or assigns from any liability arising from any behavior or actions of the dog including, but not limited to, biting, chewing, jumping, pulling and destruction of personal property. *