Date (mm/dd/yyyy) :
Volunteer Interest: While holding your Ctrl button
Pick all that apply
Foster Home
Cainine Big Brother/Sister
Fundraising
Driver License Number :
Name : (First, MI, Last)
Present Street Address:
City:
State:
Zipcode:
How Long have you lived at this
Are you planning to move in the
If you do move, what will you do with
Home Phone Number:
Cell Phone Number:
Work Phone Number:
E-Mail Address:
Are you over 18 years of Age?
Occupation:
How Long are you away from home
Your Current Home Environment
Type of Home you currently live in:
Pick One
House
Duplex
Apartment
Condo
Mobile Home
Other
Do you have a fenced yard?
Pick One
Wood
Chain Link
Vinyl
Other
The following questions only apply if you do not own your home:
Name of apartment complex, mobile
Are Pets Allowed?
Please list any pet restrictions (i.e.,
Have you notified them of your
Members Within Your Household
How many Adults live in your home?
How many children live in your
Do any members of your household
Information of Current Pets
Please list all of the pets currently Type of Pet (dog,cat,ferret, etc.
Are any of these pets kept outdoors?
Are all of these pets spayed or
If you answered "No", which pets
Veterinarian Information:
Veterinarian's Name:
Veterinarian's Address:
Veterinarian's Phone Number:
Pet History
Have you had any other pets in the
If yes, list the Type of
Have you adopted any pets from a
If yes, please list the name of the
Where is this pet now?
Pet Specifics
What gender of dog are you
Pick One
Male
Felmale
No Preference
What age of the pet are you
Pick One
Adult (over 1yr to 3yrs)
Adult (over 3 yrs)
Older Puppy (5 mos - 1yr.)
Puppy (Younger than 5 mos.)
No Preference
What size dog are you interested in
Pick One
Toy (Under 10 lbs)
Small (11 - 25 lbs)
Medium (26 - 50 lbs)
Large (51 - 90 lbs)
Giant (Over 90 lbs)
No Preference
How active would you like your dog
Pick One
Very Active (needs lots of exercise)
Active (needs moderate exercise)
Sedentary (couch potatoe)
No Preference
My foster pet will live...... Live indoors - only goes outside for potty Live outdoors - spends most of the day
Pick One
Indoors
Outdoors
Undecided
Will you leave your pet outside while
Will you leave your pet outside while
Will you be using a tie-out or chain
When your pet is left by itself, the
Where will your pet sleep at night?
How long will your pet be left by itself
If you do not have a fenced yard,
List your personal reasons for
Are you willing to allow a
Use this space for any additional
Medical Information:
In case of emergency, I authorize Hope Rescues to notify the contacts listed below. Personal/Professional emergency contacts
1st Contact Name:
1st Contact Phone Number:
1st Contact Relationship to you:
2nd Contact Name:
2nd Contact Phone Number:
2nd Contact Relationship to you:
Please read all of the following before signing your initials in the space provided after each statement
I / we, the undersigned adopting party, understand and agree to the following terms and
1. To agree to notify Hope Rescues
2. To agree to notify Hope Rescues
3. To treat this pet as a family pet
4. To always keep this pet within a
5. To never leave the pet
6. To never transport this pet
7. To regularly check the tightness
8. To notify Hope Rescues of a
9. To allow Hope Rescues to
10. To contact Hope Rescues if
11. I authorize my vet to release pet
12. To notify Hope Rescues if the
13. To administer any medications
I / we further understand and agree that:
1. Hope Rescues has advised me/us
2. Hope Rescues has advised me
RELEASE OF LIABILITY:
By your signature below, you hereby certify that the information given above is truthful and correct and that
Your Name
Date
