EmailMe Form - Hole In One Animal Rescue Dog Adoption Application

Name of pet(s) you are interested in adopting. *

Personal Information

Name *

First Last

Address *

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

Home phone

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

Mobile phone *

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

Email *

How long have you lived at your current address? *

If less than two years, what was your previous address? *

Do you rent or own? *

Rent

Own

If you rent, please provide your landlord's name, address, and phone number. *

Do you have your landlord's permission to get a dog? *

Yes

No

NA

Are you aware of pet deposit and monthly fees (if required)? *

Yes

No

NA

Do you have a fenced yard? *

Yes

No

If yes, type of fence and height *

If you do not have a fence are you prepared to walk your dog multiple times daily despite weather conditions (cold, hot, rain, snow, etc,)? *

Yes

No

NA

What is your family's lifestyle like? *

Do you have children? *

Yes

No

If you have children, please list name(s) and age(s): *

Why have you decided to get a dog? *

What are you looking for in a pet? *

Who will be responsible for taking care of the dog? *

How many hours per day will the dog be alone? *

Where will the dog stay when no one is at home? *

Where will your dog stay when you are in the home? At night? *

How often will you exercise your pet? *

Who will care for your dog when you are out of town (vacation, etc.)? *

Under what condition(s) would you have to give up your dog? *

Please tell us about any pets you currently have. Please provide name(s), breed, age & indicate if they have been spayed/neutered. *

If applicable, please provide the following information about any pets you have had in the last 5 years that are no longer with you: *

Current vet information (include name, address, phone number): *

Please provide three (3) references: *

	Name	Phone Number	Years Known
Reference #1
Reference #2
Reference #3

Agreements for Adoption

Please read carefully and indicate agreement of terms and conditions.

Agreements for Adoption:
* I am prepared to make a lifetime commitment to my dog.

* I will keep my dog on a regular routine of heartworm preventative.

* I will provide flea/tick control as needed.

* I will work with my vet and agree on a regular schedule for wellness visits, inoculations, and any other tests we agree are necessary for the health and well-being of my dog.

* I will not chain or tie-up my dog and leave it outside along. My dog will be an indoor dog and an important member of my family.

* If, for any reason, I am unable or unwilling to keep this dog, I agree to return him/her to the Original Pet Owner. I will not give this dog away, take it to a shelter, place him/her with another person or family member, or sell this dog to any other person without the express permission of the original Pet Owner.

* I am financially able to provide routine and emergency care for this dog for his/her lifetime. This includes but is not limited to food, boarding (if necessary), regular vet care, heartworm preventative and flea and tick preventative. *

I agree to the terms of this agreement.

I agree to the $25.00 application fee and understand if my application results in an adoption from HIOAR, the fee will be deducted from the adoption fee.

Please send application fee via PayPal to holeinoneanimalrescue@yahoo.com.

Please select "send to friends and family."

By submitting this form, I confirm that all of the information I have provided is true and complete. This dog will reside in my home as a family pet. I will provide it with quality dog food, fresh water, indoor shelter, and regular veterinary care.