AdoptApp

Havanese Rescue Inc Dog Adoption/Foster Home Application

Please read this first.
Occasionally, potential adopters provide foster care for a rescue dog before the adoption is finalized. This gives everyone time to see if the dog is a good match for the family. Due to this, we ask that you complete all sections of this application, even if you don't plan to become a regular volunteer for Havanese Rescue. Thank you!

IMPORTANT: Please select your state of residence (or Canada - at bottom) from this drop-down list.
Failure to do so WILL delay the processing of your application

Your first name:

Your last name:

Your Email address:

Today’s Date:

Your age:

Application Type

- Tell us what you are interested in doing:

I am interested in:

Adoption Only

Foster To Adopt Learn more about Foster to Adopt

I am interested in adopting/fostering a specific dog featured on the HRI web site, the dog’s name is:

If you are interested in volunteering with HRI, please go here and register as a volunteer.

Household Information

Address

Alternate address if applicable

Address

Alternate Address

Address line two

Alternate Address line two

City, State, Zip

Alternate City, State, Zip

Home Phone

Alternate Home Phone

Work Phone

Alternate Work Phone

Cell Phone

Alternate Cell Phone

Best time to call

Alternate Best time to call

Please provide the following information for each person, other than the applicant above, who will be living in the household with the dog, starting with the spouse or significant other. Use the freqent visitors space if you have more than four family members.

Name

Age

Relationship

Please provide information on other frequent/regular visitors to the home.

References

Please provide a list of four (4) references (only 3 will be contacted), only ONE of which may be a relative, who are familiar with your home
and pets. You must include a phone number for each reference.

Name

Relationship

Phone (include area code)

Reference #1

Reference #2

Reference #3

Reference #4

Please provide a veterinary reference who can confirm vaccination and heart worm testing records for your current pet(s). If you do not have any pets currently, please provide the name of a vet who cared for your pet(s) within the last five (5) years. Even if another member of your household owned the pet(s), veterinarian information must be provided.

Vet Name

Clinic Name

Phone Number

Vet Address

Vet City, ST, Zip

If this is not your regular vet, please explain:

Residence Information

Type of dwelling:

Have you verified that you willl not be violating any local ordinances/association by-laws/tenency rules, etc., related to the number or size of dogs you are permitted to have in your house if you foster or adopt a Havanese?

In Compliance with Laws?

Yes

Do you rent or own?

Landlord Name/Address (if applicable).

Landlord phone number with area code.

Rent

Own

Do you have any plans to move in the near future?
If yes, please elaborate.

Do you currently have a fenced yard?
Please explain what type of fence it is and how high.

Do you have a pool? If yes, describe how the dog will be protected from drowning.

If you indicated that you do not have a fence, how do you plan to handle exercise and toilet duties? Please explain in detail.

Dog Care & Guardianship

Why do you want to adopt a Havanese?

Please explain if you have a preference for a male
or female only.

Would you be willing to adopt a Havanese mix?

Are you willing to work through any house training
adjustments? Please explain.

Is everyone in the household committed to adopting
a Havanese? If no, please explain.

Who will be the primary caregiver for the adopted dog?

Would you adopt a dog with temperament issues? Please indicate
any behaviour you would NOT be comfortable dealing with.

Have you ever fostered or adopted a rescue dog before? If yes,
please provide the name of the shelter/rescue group.

Do you have a preference regarding the age of the dog?

No Preference

Puppy only (1-12 mo)

Young (1-7 years)

Middle age (8-12 yrs)

Senior (12+ years)

Do you have any experience in working with dogs in the following areas?

House training

Agression

Physical handicaps
(blind, deaf, etc.)

Puppymill Dogs

Shyness

Abused/neglected
dogs

Other, please
explain:

Are you willing to provide medical treatment to the dog? Check all that apply.

Monthly Heartworm Medication

Monthly flea & tick preventative (If recommended in your area)

Daily medication for various conditions

Injections (for diabetes, etc.)

IV fluids (for kidney disease)

Frequent medicated bathing for skin problems

Where will the foster dog spend it’s days?

Where will the foster dog spend it’s nights?

Is someone home during the day?
If not, what are your work hours?

How many hours per day, on average, will the dog spend alone?

Who will care for the dog in your absence? (vacation, etc.)

Pet History

Please list the following for each dog you currently own:

Current Dog(s) Name(s)

Current Dog(s) Sex(s)

Current Dog(s) Age(s)

Current Dog(s) Breed(s)

Please explain how many dogs you have owned in the last
10 years and what happened to them.

If any of your dogs are not spayed or neutered,
please explain why.

Do your dogs spend most of their time indoors or outdoors,
and why?

If there is anything else we should know about your dogs
please explain it here:

Please describe how many cats you have owned in the past
10 years and what happened to them.

How many cats do you own currently and are they spayed/
neutered?

Are they indoor cats or outdoor cats?

How do your cats interact with dogs?

Do you currently own any pets other than cats or dogs?
If yes, describe them please.

How do these pets interact with dogs?

If you have ever lost, surrendered to a shelter/rescue, placed in another home or given a pet away, please explain why.

Please describe any unusual characteristics of your current pets that Havanese Rescue should be aware of.

Please provide any other information which you wish us to consider in evaluating your application.

Do you agree to allow a representative of Havanese Rescue Inc to visit your home by appointment?

Yes

Havanese Rescue Inc reserves the right to refuse or deny any application. By submitting this form you attest that all the information contained in this application is complete and truthful. In addition, you expressly authorize Havanese Rescue Inc to verify the information on this application. Any misrepresentation will constitute grounds for automatic rejection.

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