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: * 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? If you are human, leave this field blank. Δ
