EmailMe Form - Homeward Bound Rescue Dog Adoption Application

Date Time *

MM / DD / YYYY

Name of the dog you are
applying for?
See next question re bulldogs
if the dog you are applying for is not ready this application will not be accepted *

DO you wish to be added to the English bulldog or French Bulldog wait list
YOU WILL ONLY BE CONTACTED ONCE THERE IS A SUITABLE DOG ( please note we have a long list for both English and French Bulldogs - please be patient) *

YES

NO

We have two separate lists - please indicate which you would like to be on *

English Bulldog

French Bulldog

Both

NONE

Name *

First Last

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

PLEASE NOTE WE DO NOT ADOPT OUTSIDE ONTARIO.

Phone *

### - ### - ####

best number to reach you

Email *

Age *

Occupation and Employer *

Spouse's Name *

Spouse’s Occupation and
Employer *

Personal Reference (name and
phone number) *

Phone *

### - ### - ####

please advise reference you have given this info out

Reference who has known your
pets, and you as a pet owner
(please provide name, phone
number and relationship) *

Phone *

### - ### - ####

What type of dwelling do you
live in (ex. house in the country,
single family home, townhome,
condo, apartment, trailer)? *

If you rent, please provide name
and phone number of landlord
** IF YOU DO NOT RENT PLEASE USE N/A *

Phone ( IF NOT APPLICABLE PUT 0000)

### - ### - ####

Please Provide if you rent

Yard size and fence height and
type *

Do you have a pool? *

Yes

No

If the pool is not fenced, how do
you propose to handle the dog’s
exercise and toilet duties? *

Do you have a dog run and if so,
what is the size? *

How many people reside in the
home?
what is the relationship to you if not spouse /children *

How many children (UNDER 18
? *

Children’s age(s) *

Do you or any members of the household smoke or vape *

Yes

No

Sometimes

If you answered yes to smoking where does it take place *

Inside home

Outside Home

both inside and out

N/A

Are any members of the
household home during the
day? *

Yes

No

Sometimes

Does anyone in the home have
any allergies to animals? *

Please explain

Other pets in the house (please
list name(s), age(s), breed(s),
please attach
pictures *

PLEASE NOTE:

HBR does not adopt outside of Ontario and will not adopt to homes with Intact dogs (unless in a breeding contract or for medical reasons) proof must be supplied.

Vetting- Spay/Neuter ( this is verified with your vet) *

Spayed/Neutered

Not Spayed or Neuterd

N/A

Vetting- Vaccines ( this is verified with your vet) *

Vaccinated

Not Vaccinated

N/A

IF YOUR ANIMALS ARE NOT SPAYED/NEUTERED OR VACCINATED PLEASE EXPLAIN WHY *

File Upload

Do you have cats? *

Yes

No

Are your cats fully vetted ( Fixed and vaccinated) this is verified with your vet *

Yes

No

N/A

Name of veterinarian *

Phone *

### - ### - ####

Approximate date of last visit *

How many dogs have you
owned in the last 5 years? What
happened to them? Did they
pass away? If so please list cause and age *

What are your plans for the dog
you plan to adopt? (pet, guard,
hunting, obedience) *

Where will the dog spend most
of the day? *

How many hours will it be left
alone each day on average? *

Where will the dog sleep at
night? *

When your family is away from
home overnight or on vacation,
what will you do with the dog? *

Would you agree to return the
dog to HBR if you can’t keep it? *

Would you agree to a home visit
prior to adoption? *

Would you agree to regular
health care for the dog? *

Have you or any member of
your family ever been convicted
of a charge of cruelty to
animals? *

Yes

No

Any any such charges pending? *

Why do you want to acquire a
new pet at this time? *

How much do you think it will
cost to feed the dog (per
month)? *

How much do you think
veterinary care will cost (per
month/year)? on average *

What other expenses would you
be prepared to pay? *

What is your definition of
disciplining your dog? *

What issues will you not
tolerate with a dog? (behaviour) *

Would you work with the dog?
ex. with a dog trainer *

How did you hear about
Homeward Bound Rescue? *

ARE YOU IN THE PROCESS OF APPLYING TO OTHER RESCUES *

YES

NO

DO YOU UNDERSTAND THAT YOU WILL ONLY BE CONTACTED IF YOU ARE DEEMED TO BE AN APPROPRIATE MATCH FOR A HBR DOG? *

YES

NO

Do you understand that if your application is filled out but incomplete , it will automatically deleted *

YES

NO

Name (signature ) *

AGREEMENT
I attest that the information provided on this application is true and accurate to the best of my knowledge. By submitting this application to the Homeward Bound Rescue, I agree and consent to the collection, use and transfer of my personal information for the purposes of processing my application.
Please note: By submitting the adoption application you are testifying that it, and all accompanying
documentation, is true and factual. Homeward Bound Rescue reserves the right to reject any application for
any reason at any time.