HHBCR Adoption Application Name of dog you are applying to adopt * Contact Information All fields with red asterix (*) must be filled in Name * Address * Phone * Work Phone Cell Email * Family Information Are you currently employed? * yes no full time part time Name of reference (not a relative) * Reference Phone * Please list number of people living in your home: * Age of primary care giver * Do you own or rent your current place of residence? * own rent If renting, do you have permission from your landlord to keep a dog? yes no Landlord's Name & Phone Number Do you have other pets at the current time? * yes no If yes, what type and how many? Are your current pets all spayed or neutered? yes no Are your current pets all up-to-date on their shots? yes no What do you feed your current pet (s)? If you have no pets, what will you be feeding your new dog? What Brand? * If you are human, leave this field blank. Δ
