Harnessed to Hope Northern Breed Rescue Adoption Application

Harnessed to Hope
Harnessed to Hope Northern Breed Rescue
PO Box 21125
Lehigh Valley, Pennsylvania 18002
1-866-65-RESCUE          www.nbrescue.com
HTHNBR is a non-profit organization as recognized by the
Internal Revenue Service
pursuant to Section 501(c)3 of the Internal Revenue Code.
Please answer all questions to the best of your ability. Missing information may cause a delay in processing your application.
Best time to call: *
Is age of applicant under 18?
If so, how old is the applicant? * 🛈

Personal References:
Please list three references (only one can be a family member) *
 NameRelationshipPhone Number
First Reference
Second Reference
Third Reference

Please list all members of the household: *

Are there regular visitors to the home that the dog will be interacting with?
If yes, please describe (young children, elderly, other dogs, etc.) *

Is everyone in the house agreeable to adoption? *
Do you own or rent your home?
If you rent do you have landlord permission? *
NOTE: If you rent your home, please have your landlord fax a statement saying that your lease does allow you to have a dog. Please ask them to include any limitations on having a dog that your lease includes, such as maximum weight, any breeds that are prohibited, etc.

The statement should be faxed to 866-657-3728 (this is our fax number as well as our phone number) to the attention of Harnessed to Hope Volunteer Staff.
Do you have plans on moving?
If so, when? *

Do you have a fenced in yard? *

Have you researched the breed(s) that you are interested in? *
What type of research have you done? *
Have you ever owned a: *
Do you currently have any dogs? If so, please list each one below. *
Dog 1
Dog 2
Dog 3
Dog 4
Dog 5
Dog 6
Dog 7
Have you ever owned a dog in the past 10 years that you no longer own? If yes, please explain what happend to the dog you no longer own. *
Do you have any cats?
If so, how many? *
Have the cats ever met a dog?
If so, how did they get along? *
Have you ever owned any cats in the past 10 years that you no longer have?
If so, what happend to the cats you no longer have? *
Do you have any other pets?
If so, Please list here: * 🛈

What breeds or mixes are you interested in? *
Is there a particular dog on our website that your interested in adopting?
If so, which one? (We do our best to match each adopter to the dog they like, but please note we cannot guarantee that this dog will still be available at the time of your adoption.) *
Do you have a gender preference? *
Do you have an age preferance? *
Plans for dog: *

Please note the importance of each of these characteristics. We will use this information to find the right match for you. *
 UnnecessaryWilling to TrainPreferredEssential
Crate Trained
Good With Babies
Good With Young Children
Good With Dogs
Good With Cats
Good With Small Dogs
Good with Small Animals
Turstworthy off Leash
Trustworthy in house alone
Has no known medical issues
Good in Dog Parks
Doesn't Pull on a Leash
Does Not Dig
 CrateLoose in HouseLoose OutdoorsKennel RunTie OutBasementIn Bed With OwnerOther
Where will the dog spend its time during the day?
Where will the dog sleep at night?
How many hours a day will the dog be alone? *
Do you currently have a veterinarian? *
Is this your current Vet?
If not, Why? *
Have you applied to any other rescue?
If Yes, which one(s)? *
Do you agree to allow a represenative of HTHNBR to come to your home?
If no, why not? *
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