Fill and Sign the Charging Party Intake Form State of South Dakota State Sd

Friends Of Hannah Rescue, Adoption & Sanctuary ADOPTION APPLICATION The answers you give on this application help us to find the best possible match between you and the dogs available through Friends Of Hannah. Please fill out the form completely and return it to percy40@comcast.net or to Friends Of Hannah, 123 Big Station Camp Boulevard, Gallatin, TN. 37066. Our adoption fee is $125 which helps cover all costs associated with vetting costs, including, but not limited to spay/neuter, heartworm check, deforming, flea prevention, Rabies, Distemper/Parvo combination, and Bordetella vaccinations, as well as microchipping. Your Contact Information Your Occupation____________________ Name___________________________________________ Address______________________________________________________________________________ City________________________________ State______ Zip______________ Email________________________________________________________________ Home Phone_____________________________ Work Phone________________________________ Cell Phone______________________________ call_____________________________ Best time to What specific dog are you interested in? _____________________________________________ Have you applied to other rescues? YES NO If YES, please give name_______________________________________________________________ _____________________________________________________________________________________ References: We require two references, one personal and one veterinarian. If you do not have a veterinarian, list another personal reference. Personal Reference_______________________________________Relationship_________________ Phone Number(s)_____________________________________________________________________ Vet’s Name (or alternate reference)_____________________________________________________ Phone Numbers_______________________________________________________________________ Household Information Number of adults in your household_________ How many children under age 12____________ List names and ages of children_________________________________________________________ _____________________________________________________________________________________ List any regular visitors to your home (animal and human), with which your new dog must get along with____________________________________________________________________________ _____________________________________________________________________________________ Do you own other dogs? YES NO Are they spayed/neutered? YES NO Do you own any cats? YES NO Are they spayed/neutered? YES NO Are all pets current on vaccinations? YES NO Are all pets on flea control? YES NO Are all dogs on heartworm preventative? YES NO Give Names, breed, sex and age of pets in household: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ What other animals do you have in or around your home?_________________________________ _____________________________________________________________________________________ How many dogs have you _______________________________________ owned in your lifetime? How many dogs have you owned in the last 5 years?______________________________________ Have you ever had to give up a dog for any reason? Do you live in a (circle one) home other house YES NO apartment Do you rent or own?___________________________ address?________________ condo How mobile long at this Your landlord’s name and phone number________________________________________________ Do you have a fenced yard? fencing?________________________ YES What size dog do you prefer? Tiny What sex dog do you prefer? Female Circle all plans for this dog: someone pet Age Preference: puppy stage Coat Preference: preference no shed NO Small Medium Male guard less than 6 months low shed Training Preference: no training preference If Large so, kind of No Preference No Preference breeding companion less than one year short hair some training what adult out of chewing medium hair well trained gift for long hair housetrained no no Where will the dog spend the day? (circle all that apply) Indoors Chain Crated Garage Fenced Yard Loose in House Loose Outside On Runner Where will the dog spend the night? (circle all that apply) Indoors Runner Crated Chain Garage Fenced Yard Loose in House Loose Outside On On average, how many hours a day will the dog be left alone?_____________________________ Filling out this application in no way guarantees your adoption of a dog from Friends Of Hannah. Your signature on this application attests that the information that you have given is accurate and true and gives us permission to contact your veterinarian and for them to provide any information requested by us in regard to medical and preventative care provided any current or past pets that they have on record. _______________________________________________________________ Date_________________ Signature