Your Full Name: (required)

Street Address: (required)

Dog Preference

Questionnaire

Who Will Care for Your Dog in Case of Emergency or When You're On Vacation?

How Many Hours a Day Will Your Dog Be Alone?

Activities You Participate In That Will Include Your Dog?
HikingSwimmingHuntingAgilityCampingOther

Your Level of Experience As a Dog Guardian:
Very ExperiencedSome ExperienceNo Experience

Do You Intend to Provide Your Dog with a Loving Home For the Rest of His/Her Life?

What Characteristics Do You Expect of This Dog?

Under What Circumstances Would You Consider Surrendering Your Dog?

Have You Had Any Dogs in the Past 5 Years That You No Longer Have? If So What Happened?

How Would You Describe Your Levels of Energy and Activity?
Couch PotatoModerate EnergyActiveEnergizer BunnyHigh DriveOther

Would You Consider a Special Needs Dog, Such As One That Requires Daily Medicine or Has a Disability?
YesNo

When Will You Be Prepared to Adopt? (Required)
NowLater

If Later When?

Do You Agree To a Home Check?

Any Additional Comments You Would Like to Share with the Individuals or Committee?

Other Comments:

A rescue dog may have experienced an unfortunate history of one or more of the following:

Abuse, abandonment, loneliness, insecurity, distrust. A period of adjustment (days for some weeks for others) should be expected in some instances. Ofter the new dog is so grateful and overwhelmed with your show of love, devotion, and consistency that she/he relaxes immediately and opens her/his up to you. In either case, a rescue dog is almost always grateful, loyal, very affectionate, eager to play, very companionable, submission of your application does not guarantee the placement of a dog. Applicants must agree to a home visit if asked for one.

I understand that any misrepresentation of facts may result in the removal of the placed dog from the home. I understand that Battle Mountain Humane Society is not responsible for the accuracy of the information received about the temperament, habits, or physical condition of dogs available for adoption. Battle Mountain Humane Society is neither liable nor responsible for any damage in an accident resulting from the placement of this dog, I will accept the responsibilities for the health, housing, feeding, training, and companionship of this dog.

Agree

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