Maggie
Project Halo
Helping Animals Live On
Ellie

Adoption Application

Name:  
Email Address:  
Street Address:
City:  
State:  
Zip Code:
Home Phone:
(enter numbers only)
Work Phone:
(enter numbers only)
Cell Phone:
(enter numbers only)
Age:
Date Of Birth:
(dd/mm/yyyy) 		 
Employment Status:
Number of Adult Family Members:
Number of Children:
Ages:
Do You or Other Family Members Have Pet Allergies?
Type of Residence
Do You:
How Long Have You Owned/Rented?
Landlords Address/Phone:
Home Location:
Traffic:
Speed Limit:
Do You Have a Fenced Yard or Area?
If Yes, What Size/Height:
Will the Dog Run Loose (Off Leash)?
Preferred Breed(s)
Preferred Age
Preferred Size
Preferred Color(s)
Preferred Gender
Why Do You Wish to Adopt a Rescue Dog:
Which HALO Dog(s) Are You Interested in:
Where Did You See or Learn About This Dog:
Have You Had Pets Before:
What Happened to These Pets:
List Any Current Pets in the Home:
Current or Past Veterinarian:
(Veterinarian) Address/Phone:
Who Will Be the Principal Caretaker?
Who Will Care for the Dog When You Go Out of Town?
Hours Per Day the Dog Will Spend Alone?
Where Will the Dog Stay When Alone?
Where Will the Dog Spend Most of Its Time?
Where Will the Dog Spend Most of Its Nights?
Are You Willing to Provide Routine Medical Care, Including but not Limited to Vaccinations, Rabies, Monthly Heartworm Prevention, Monthly Flea & Tick Prevention, and Yearly Exam?
Are You Willing to Provide Emergency Medical Care if Your Dog Gets Sick or Injured?
How Will You Train Your New Dog?
How Will You Help Your New Dog to Adjust to His New Home?
How Long Will You Allow for Your New Dog to Adjust?
How Much Exercise Will You Provide for Your Dog?
What Type of Exercise Will You Provide:
What Will Happen to Your Dog if You:
Move?
Get Married/Divorced?
Have a New Baby?
Take a New Job?
Get a New Roommate?
Adopt Another Dog/Cat?
For What Reasons Might You Need to Return the Dog to Project HALO?
Personal Reference (non-family member):
Address/Phone of Reference:
Comments: