Dog(s) of Interest (required) :
Your First and Last Name (required)
Significant Other's First and Last Name: Your e-mail address (required)
Your Home Address (required) :
City (required) :
State (required) :
Zip Code (required) :
Home Phone (required) :
Cell Phone (required) :
Work Phone (required) :
Your Occupation (required) :
Your Employer (required) :
Hours You Work Per Week (required) : Name of Current Veterinarian (required) :
Current Veterinarian's Phone (required) :
How long have you lived in Arizona (required) :
How long have you lived at your current residence? (required) :
Do you live in: (required) :
Do you own or rent your home (required) :
Landlord/Apartment Complex Name (required if you rent) :
Landlord/Apartment Complex Phone Number (required if you rent) :
If you rent, have you paid the pet deposit (required if you rent) :
If you are a renter, does your rental agency/landlord have restrictions on dogs (required if applicable) :
If yes, what are the restrictions (required if applicable) :
Are you planning to move soon (required) : Age Preference for Dog - check all that apply (required) : Gender Preference for Dog (required) : What physical characteristics do you want your dog to have (answers for coat length, size, color required) : Size:
What personality traits do you want your new dog to have (Check all
that apply) (required) : Describe other desired activities:
Describe other desired qualities:
What do you want your dog to be (required) :
If you selected "Both" please choose how much time the dog will spend outside: Have you adopted a HALO Rescue Animal before (required) :
If yes, who and what type of animal did you adopt: Have you had animals before (required) : What type of animal(s):
What happened to your animal(s): List the pets you CURRENTLY have (if none, type "N/A"). If there are more than three, that's OK with us, just use the "Additional Comments" space at the end of this questionnaire to list any other pets:
List the pets that you DO NOT HAVE , but lived with you within the last 5 years (if none, type "N/A"). If there are more than three, that's OK with us, just use the space at the end of this questionnaire to list any additional pets:
Does your home have a pet door to the outside (required) : Is your yard fenced (required) : What type of fence (required if applicable) :
How tall is the fence (required if applicable) :
Does your home have a pool (required) : Is your pool fenced (required if applicable) : How many children live in your home and what are their ages (required) :
How many adults live in your home (required) :
Is anyone in your home allergic to cats and/or dogs (required) : How often do children visit your home (required) :
Is this animal a gift (required) : How many hours per day will your dog be unattended while your family
is at work/school (required) :
Where will your pet be while you are away (required) : If "Other," explain where: Where will the dog stay at night (required) : Your family's activity level is (required) : When you are out of town, you plan to (required) : If you had to move, you would (required) : Are you familiar with crate training (required) : Will you crate train (required) :
How did you hear about HALO? Additional Comments:
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